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Credit to Dr. Rob Landel for this week's quote, unabashedly lifted from one of his excellent comments. A great quote from one of my favorite writers:
The whole problem with the world is that fools and fanatics are always so certain of themselves, but wiser people so full of doubts. --Bertrand Russell
Given the posts on the "Guru issue" - I found the keynote speaker at the PPS annual conference intriguing http://www.ppsapta.org/calendar/2006ac/keynote.asp Obviously it is not fair to judge Dr. H until we hear his remarks and how he relates his area of expertise to the PPS membership. On the surface is this the type of keynote we need in light of the discussion about guru's and their approach to "improving" our profession and the timing of moving the profession in an evidenced based direction? If anyone has insight into this Keynote speaker I would like to know more (and hopefully so do others) so I can better understand this choice. Hopefully Dr. H is more in line with what we need than the type of guru we have blogged about.
Jeff
I know this is not a clinical question perse, but I was wondering what would be a good way to prepare for the OCS exam. I am aware of the home study course put out by APTA, orthopedic section, but I was wondering if this is good enough or if there are any other suggestions. Thank you.
Greg
The EIM Team is pleased to announce yet another new and exciting platform to deliver information to the EIM community around the world. We have launched the EIM Podcast! The url address for the podcast is http://feeds.feedburner.com/EIMPodcast. You can also subscribe automatically via iTunes or other popular RSS readers by clicking on the appropriate 'chicklet' (button) within the the 'EIM Podcast' typelist located on the left hand side of the blog (http://blog.evidenceinmotion.com).
In the coming months, we will interview key leaders within the physical therapy profession and make these interviews available. We will also podcast on any number of current topics affecting our profession. If you'd like us to interview someone in particular, drop us an email at podcast@evidenceinmotion.com.
For our inaugural podcast, we are pleased to have interviewed Dr. Tony Delitto from the University of Pittsburgh and get his opinions and expertise on everything from pay for performance (P4P) to academic programs in physical therapy, research initiatives, and outcome instruments.
For a sample of the interview, we posed the following question to Tony:
Tell us about your experience of P4P implementation at the University of Pittsburgh Medical Center (UPMC). His response follows:
Our experience with the University of Pittsburgh Medical Center (UPMC) Health Plan represents a “perfect storm” for the ability to put in place various measures. The UPMC Health Plan really is the insurance product for UPM. The Health plan is a provider led plan meaning that providers make the decisions on what services that will be provided and how they are going to be paid. UPMC’s purpose really is to insure itself yet it must remain a competitive product and it is particularly interested in making sure other insurance plans use its network. Because of the ability for providers to make such decisions, we were able to implement our definition of quality and systems that could promote the type of care that we felt was best including outcome and performance measures.
Several P4P issues were brought up during the Rothstein debate. The issue of “is it really another fad” was raised and I am leaning in that direction as well-especially without a clear definition of what P4P really means. Since the 1990’s, we have been geared up for the quality movement but instead we continue to have a cost based system where the efforts are solely directed towards saving money. I also believe that P4P will have inevitable “gamesmanship” that will be counterproductive towards the whole effort.
This is just a small sample of our interview with Tony. Let us know if you have any questions and stay tuned for frequent updates. Join us soon on the EIM Podcast!
Podcasting Evidence into Practice,
The EIM Team
Please bring the violin out and carry some extra kleenex today. I was thinking of the title of this post-a Yogi-ism while reading this WSJ article (available for non-subscribers of WSJ for 7 days) which points out how health insurers who have made a combined $10 billion in profits over the past five years may now see their profits decline. Cyclical earnings and then decline are not new in the insurer segment. They extract major profits due to the combination of imposing significant rate increases on employers as well as decreased reimbursement to providers (individuals as well as facilities). Eventually employers (who are the customers) revolt which puts pressure on these companies and the trends reverse.
The real reason that I posted this article is not to point out the obvious but to point out the quotes by the executives of these companies which are at the end of the article. Par usual, the "ultimate solution is to drive more price and quality data to consumers to steer towards cost effective care" and to continue the recent trend towards "consumerism".
All this reminds me of yet another Yogi Berra quote-"the more things change, the more they stay the same"
Larry
I would not consider myself a fan of Bill O'Reilly, noted author and host of "The O'Reilly Factor" on Fox News, but I do appreciate his no-nonsense approach to journalism and his attempts to get past the palaver and half truths that are promulgated in the media and by the government. In his program, he invites people to discuss current issues with him by coming into "The No-Spin Zone," which according to him, is a "nightmare place for charlatans and deceivers, but a great place for those who believe in truth and common sense."
Our profession of physical therapy unfortunately contains a great deal of "spin." There are therapists whose practice patterns contain only shreds of credible evidence. There are gurus whose seminars are more mythical than factual. And there are vendors whose products and devices are more commercial than therapeutic. We can't change our profession overnight, but as each individual therapist decides to follow the evidence--establishing a personal "no-spin zone" in regard to his or her own practice patterns--falsehoods and deceptions will be eliminated and truth will be revealed.
According to Mr. O'Reilly, "A personal no-spin zone will save you time, money, and frustration. It will allow you to make value judgments based on hard facts and evidence. And provided that you keep an open mind and examine all available credible data, you'll be comfortable with your conclusions on most matters. Here's the key that unlocks the zone: the ability to be rigorous with yourself and always challenging your thoughts and conclusions. The zone is no place for zealots, lemmings, or weak minded followers. It is a state of mind that demands the discipline of clear thinking and the flexibility to change that thinking should the evidence dictate."
So, here's to establishing a "no-spin" profession--one evidence based practitioner at a time!
Evan
I am fuming! I just read the CMS proposed notice on reducing the work relative value units (RVU)! For those of you that don't know the significance of RVUs, well, basically the RVU is one factor that is utilized in the calculation of the fee schedule which determines the payment for services. Simply, the lower the RVU, the less the payment for services.
Our "work" hasn't changed one bit! Basically, CMS is robbing Peter (physical therapists included in this group) to pay Paul (physicians). Earlier in the year, there was some legislation that would increase payment for evaluation and management services (codes utilized to physicians). That's great for the physicians.... but apparently to offset the anticipated increased cost in paying physicians, there needs to be cuts elsewhere. I remember when I read that change thinking to myself, how can CMS afford to do that? Obviously, my thoughts were right on, because apparently CMS can't afford to implement that change! WHAT were they thinking??? Who makes these decisions?
Now, to make it sound reasonable, supposedly practice expense values will be increased over the years so that by 2010 the increase will be fully implemented.
There has GOT to be a better way for CMS to afford to pay for services! Reducing the RVUs is just not acceptable to me. Technically, the "work" involved in treating Medicare patients is a LOT more difficult AND it is getting worse! Let's see... explaining the cap... checking to see if the ICD-9 code is "exempt"... but even if the code is "exempt" remembering to use the KX modifier when the limit is close to approaching... keeping track of patient accounts much closer to ensure that in non-exempt cases the patient does not go over the limit... extra phone calls to home health agencies IF the patient had recent home health services and there is no indication that services were discontinued (the phone call is to alert the home health agency that outpatient services are being started and also to request written verification that the patient is discharged from the home health agency).... prior to billing out for services - reviewing the ICD-9 code(s) and verifying that the CPT codes that will be utilized ARE payable under that ICD-9 code.... oh, and staying on top of the ever changing rules and regulations regarding supervision and one-on-one and documentation requirements.... ALL of that above SHOULD be part of the RVU in some way, shape or form. CMS has got to be the most complex and ever-changing payer out there!
You know, it's just getting to the point where I feel like saying, "screw you." I feel like unparticipating myself and dealing with whatever repercussions occur in my little community and seeing what happens.
1. Is there any research regarding relative risk odds ratio or benefit ratio for PT's advising on OTC drugs?
2. Have there been any reports of adverse outcomes from PT's recommending OTC drugs and where would we find this information?
Thank you very much for your help in this matter.
Carina Lowry
APTA members,
Please take a few minutes to nominate Stephen McDavitt PT, FAAOMPT to a second term as a Director of APTA BOD. He has been a tireless worker for the APTA and the PT profession. He brings a wealth of experience as a private practice PT and an advocate for professional practice issues especially related to manipulation and evidence-based practice. I feel that it would be a great loss to the Association if Steve were not re-elected. Click on the APTA website link to nominate Steve. It's VERY EASY. He needs nominations from individual members, State Chapters, and Sections. Thanks!
Ken
Kenneth A. Olson PT, DHSc, OCS,
FAAOMPT
Northern Rehabilitation and Sports
Medicine Associates
DeKalb, IL 60115
www.northernrehabpt.com
815-756-8524
(fax)815-756-1841
olsonpt@comcast.net
We've had some good discussions lately about both Guruism and the overmarketing of equipment on the blog lately. I had submitted this earlier as a comment, but decided to place it as a post so we could discuss it, and see the file in question.
Anybody check the latest issue of Orthopedic PT Practice?
Download optp_vol18_no2.pdf
I was dismayed to read a "case report" of the use of "multiple impulse technology" in a particuarly imprecisely written article whose poor quality and clinical reasoning errors made me actually wince. I find it hard to believe such a thing was published in our trade journal, I know it's not peer-reviewed, but I was expecting better than that.
Also in that same issue, in the pain management area (where evidently "anything goes"), a few nods to the "almost miraculous" laser treatment, which reminded me of my lovely post a while back on laser therapy and my rather unproductive exchange with Dr Joe Kleinkort, president of the pain management SIG of the Orthopedic Section of the APTA:
http://blog.evidenceinmotion.com/evidence/2005/12/laser_therapy_d.html
http://www.rehabedge.com/ubb/ultimatebb.php?/ubb/get_topic/f/25/t/001956.html#000000
I guess as long as the equipment gurus hold enough sway in our profession to get published in our trade journals and elected to APTA office, then the prospect of marginalizing them through nonpatronage seems unlikely.
Thoughts??
J