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Foot Owned Physical Therapy Services

All referral for profit (RFP) situations restrain trade, limit consumer choice, etc. However, some arrangements just seem worse than others at face value. Some of you may have already seen this, but the February edition of Podiatry Today published a 'how to' article on FOPTS ('foot' owned physical therapy services). I would put this right up there with COPTS (chiropractic owned physical therapy services)...I just can't imagine any physical therapist subjecting themselves to these environments. PT post bunionectomy anyone?

Fran Welk, Chair of the APTA Task Force on Referral for Profit, did a nice job responding to this article in a letter to the editor. The response of course from the podiatrist was the typical smokescreen verbiage you always hear in defense of RFP arrangements. Note the reference the podiatrist makes to himself as a 'physician' in his response. Sorry, you're still a FOPTS in my book.

RFP is a multifaceted issue to be sure. However, it would be interesting to know if the rates of employment in RFP settings immediately following graduation are higher in some educational programs compared to others. It just seems to me that the fact that there is a supply of PTs willing to rub feet all day and be exercise lackeys for chiros is at least partially a function of our inability to persuade them early in their professional careers that RFP arrangements are not consistent with a professional’s behavior. Do we even condone them in some programs as a way to help pay of school debt? What about educational programs that affiliate with RFP settings for their clinical education? In many ways, the onus of solving the RFP dilemma remains with us. Where there is no supply, there is no RFP.

John

Arthritis Hampers Millions on the Job

Arthritis limits work for nearly 7 million U.S. adults.  That's about 30% of people with arthritis who are 18-64 years old (Theis, K. Arthritis & Rheumatism, April 15, 2007; vol 57: pp 355-363)

While there are significant limitations to the study, there is no question painful arthritic conditions affect a great number of people on a daily basis.  The question is, what can be done to help these folks?   When you boil it down to basics, the answers really come down to:

1. Drugs-  good for minor - moderate pain; probably overutilized, real risk and harm reported

2. Surgery-  necessary in some cases; probably overutilized, real risk and harm reported

3. Us (physical therapy related interventions)- good for minor - major pain with associated impairments, functional limitations and/or disability;  probably underutilized,  no real risk or harm reported

The first step in being able to make a choice is knowing about it.  How educated are your patients and referral sources about the benefit of PT intervention for painful hip and knee OA?  Something to think about as well as how to best educate them.

Have a great weekend!

 

Rob

Check Out the Upcoming EIM Courses!!!

Check out upcoming Evidence in Motion courses currently open for registration! Learn more about MyEIM and our new Articulate course format!

Download WhatIsMyEIM.pdf

Download ArticulateFormat.pdf

***Indicates course open for internal registration only. Contact facility POC listed on website.

Evidence-based Examination and Selected Interventions for Patients with Lumbopelvic Spine and Hip Disorders

Mar 31-Apr 1, 2007
Burlington, NC (USA)

May 18-19, 2007***
Cary, NC (USA)

Evidence-based Examination and Selected Interventions for Patients with Cervical Spine Disorders

Aug 18, 2007***
Russellville, KY (USA)

Sep 15-16, 2007
Burlington, NC (USA)

Sep 29, 2007***
Everett, WA (USA)

Evidence-based Examination and Selected Interventions for Patients with Upper Extremity Disorders

May 4-5, 2007***
Navarre, FL (USA)

May 12-13, 2007
Jacksonville, FL (USA)

Oct 26-27, 2007***
W. Palm Beach, FL (USA)

Evidence-based Examination and Selected Interventions for Patients with Lower Extremity Disorders

Mar 30-31, 2007***
Palm Harbor, FL (USA)

Aug 25-26, 2007
Jacksonville, FL (USA)

Sep 8-9, 2007
Concord, NH (USA)

Nov 3-4, 2007***
Hawthorne, NY (USA)

The Pre-Participation Physical Exam: Evidence-based Muskuloskeletal Screening and Injury Prevention Strategies

Apr 20-21, 2007
Evansville, IN (USA)

We encourage early registration to insure a seat. Extensive hands-on lab sessions are included.  Visit us on the web at www.evidenceinmotion.com to get more details, learn about other 2007 course dates and locations. Register online today!

Feel free to email us at courses@evidenceinmotion.com if you have any questions or need additional information. Consider passing this post on as an email to your colleagues who might benefit from this information. Hope to see you at an Evidence in Motion course in 2007! We sincerely thank you for joining with us to translate evidence into practice.

The Evidence in Motion Team

 
 

How do we take away the stick?

I am currently reading the book by William Ury called “The Power of a Positive No – How to Say No and Still Get to Yes ”.  I recommend this book – especially for those who have a hard time saying no in a negotiation (i.e. insurance contracts) as well as managing your practice.  In this book the author talks of a Zen master who gives a cup of tea to a student and then tells the student “if you drink the tea I will beat you with this stick and if you don’t drink the tea I will beat you with this stick.”

(When I read this for some reason UHC came to mind (BTW in the WSJ read the 3/20/07 article Publicly-Traded Health Plans Lag In Customer Satisfaction Survey)).

It seems to be a no-win situation.  If the student believes that those are the only two choices then he loses his power and the pain is inevitable.  However, if the student looks at other less obvious options then maybe he can stop the infliction of the pain.  How can the student instead take the stick away thereby taking away or diminishing the masters power?  In our profession and businesses how can we take away the stick?  What does taking away the stick look like?

I believe if we know “what (or the fact that we want to)” and “why” we want to take away the stick, the “how” will come – but we (as a profession or in a certain critical mass) must first be resolved to take it away.  I wish I could extend the answer to “how” in this blog – those of you who know me, know I am not that smart!! 

Jeff

Experts Say Exercise Can Help Elderly Prevent Falls

Just Who are These Experts?

An article noticed in the Houston Chronicle provides some good information on the benefits of exercise in preventing falls and fall risk in older adults. The unfortunate thing is it features athletic trainers and orthopedists! Once again, PTs could lose an important part of our professional practice if we don’t step up to the plate, and quickly!

We have some great tools to assess both quantity and quantity of fall risk. The Berg Balance Score is an excellent tool to identify impairments related to fall risk and is an accurate tool to measure fall risk (+LR >5). Outpatient programs are the perfect place to assess fall risk, beginning with the question “Have you ever fallen?” People who have fallen have nearly a 100% chance of falling again. Interesting, this is a new quality measure that CMS is promoting to obtain a bonus of 1.5%.

A physical therapist is the best person to conduct the fall risk assessment and identify the Impairments that will drive the interventions. To be effective, these interventions need to be evidence-based, providing the appropriate intensity, specificity, and challenge to the appropriate system. In a quick Google search of PT and fall prevention, I found a news release from the CPTA that was a nice spot on the role of PTs in fall assessment and interventions. APTA also has some good resources regarding balance and falls including a brochure and a kit to conduct community fall risk screenings.

Advocate for your profession and those aging adults who don’t want to fall. PTs are the best thing to happen to older adults!

Dale Avers

APTA and DVT

That wasn't a typo.  Nope, a DPT isn't what was really meant.  Apparently there was a news release... a bit more helpful than the couch potato stuff.  It's nice to see that the APTA can step up and respond to "real" issues.

As Vice President Cheney Continues Treatment for Deep Vein Thrombosis,
Physical Therapists Offer Tips on Preventing Possibly Life-Threatening Condition

American Physical Therapy Association Says Movement and Simple Exercises Can Help Prevent Airline Aches, Pains, and More Complicated Problems

The Fitness Orb Changed My Life

When it comes to LBP we look to the evidence first but often the answer lies in the experience.  I am in my mid-40s and frankly the fitness orb has changed my life. 

Tim

Huh! I thought we came from reconstruction aids

I read with great interest a post from Medinnovation Blog (on my feedemon reader) On Physical Therapists and Keeping Patients Moving which highlighted Dr. Duvall and the great work that he and his colleagues are doing in Atlanta.

I should have stopped there.

BUT, unfortunately I read the comments where I learned that physiatrists invented physical therapy and that they are responsible for our training.

I am getting real sick right now.  Too sick to post the facts to their comments.

 

Larry

Lagging Behind

In previous posts, we have focused our criticism on payors as rogue warriors in search of ever higher margins thru the impact of decreasing costs (taking advantage of their size by making providers take it on the chin) and increasing premiums to employers (and the employees thru higher co-pays) which have resulted in some nice stock options and buying sprees in their ever increasing consolidation of about 4–5 real players in the insurance industry.

This occurs of course because they have no vested interest in aligning their policy with quality and because they forget about the sustainability of their customers (employers).  I suggest they take notice of a new survey from the National Group on Health/Watson Wyatt Consulting.

Here are some relevant findings:

-about 38% of companies now offer consumer-directed health plans (CDHPs), up from 33%

-cost sharing (e.g. higher co-pays) has not resulted in better results (savings)

Before I go on, let’s apply this to the PT world.  We are now seeing plans that some payors have implemented whereby the patient has upwards of a $50 co-pay.  Does it result in less visits in PT-you bet. Does it result in the long-term best interest of the patient-doubtful.  Does it result in impaired progress and overall dissatisfaction with the health plan-I am sure that it does.

The survey found that the best performing companies are more likely to offer meaningful financial incentives for employee education and participation than the poorer performers. 

They found that quality and providing information on the best “procedure-specific” centers coupled with financial incentives (meaning less co-pay) resulted in improved performance and savings.  If you want to save money in health care, drive your patients to the best providers thru information and then incent them to use those providers thru lower co-pays. 

 Sounds so simple.

Larry

 

On Listening, Luck, and Life

Dr. Jerome Groopman is one of those leaders in medicine that gets to the heart of many of the problems in the US healthcare industry.  His Knife in the Back piece published in the New Yorker is still one of classics on the broken and often unethical industry of modern day spine surgery.  In his new book "How Doctors Think" discussed yesterday on NPR (check out the podcast) Groopman appears to have provided yet another excllent insight on fixing our broken system.  He notes Most doctors, within the first 18 seconds of seeing a patient, will interrupt him telling his story and also generate an idea in his mind [of] what's wrong. And too often, we make what's called an anchoring mistake — we fix on that snap judgment. The book appears to have a wealth of information on how we can all improve the patient encounter.

I feel lucky that I am in a profession that values the patient's voice in a collaborative manner whether it be in diagnosis, prognosis, or intervention decision-making.  We all make mistakes, but our mistakes become fewer when we engage in active listening every day with every patient. 

On a personal note I wish everyone a Happy St. Patrick's day.  For those that know me and imbibe please raise a toast for a great man and father John Patrick Flynn who died 28 years ago today.

Tim