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Voodoo Economics

Let’s see, insurance companies margins and earnings at record highs, medical provider margins at record lows.  Today’s WSJ (available for 7 days) article gives an example of why this occurs.

In Insurers Fight to Defend Lucrative Medicare Business, we find out the immense lobbying efforts by our good insurance company friends to protect their medicare advantage plans. The number of so called Medicare Advantage plans administered by commercial carriers is expected to grow to more than 8 million this year.  Apparently, lots of lawmakers want to cut the payments made to these commercial carriers. 

Believe it or not CMS pays these commercial carriers more per beneficiary to administer medicare advantage than it would cost the government to administer itself.  The carriers then contract with providers at a rate below what medicare would reimburse and impose additional rules that arbitrarily limit utilization for no clinical reasons whatsoever and thus their margins and profits rise.

Yes, it sounds like and is a hoax-all at the expense of medical providers.

Larry 

Everything that EBP Is Not

This article represents everything that EBP is not. DonTigny has found the holy grail cause of LBP...a 'reversible, biomechanical dysfunction of the sacroiliac joints, a new concept...' He further claims to have perfected an 'extremely simplified method of diagnosis and treatment of lower back pain whereby the skilled practitioner can make a diagnosis in about five minutes and have 85 percent of patients free of pain in about 10 minutes.' The evidence and the majority of the profession has long moved past the SIJ and certainly recognizes that there are no magic bullet cures for LBP.

John

We Speak Gibberish When It Comes to Manual Therapy

The AAOMPT is actively pursuing developing a common language for manual therapy. We are all familiar with the various manual therapy camps, each of whom uses its own almost proprietary verbiage to describe clinical findings, treatment techniques, etc. You say ERS, I say closing, you say left on right, I say stuck in extension, etc. This video clip is a humorous example of the problem using a business example. We need more plain talk in PT, otherwise the medical community, other PTs, and consumers have no idea what we're talking about. The outcome from the manual therapy language task force will be a breath of fresh air. Let's stop selling retro encabulators to our patients.

John

Chondroitin

A recent systematic review published in Ann Int Med of chondroitin for reducing pain due to hip and knee  OA found no effect.

In the abstract, the authors state that they included 20 randomized and quasi-randomized trials which were described as being of generally low quality.  However, their conclusions appear to be based on the results of 3 larger, high-quality tirals that accounted for 40% of the 3,846 paitents included in the review.

Remember, this review regards chondroitin.  Chondroitin is usually included in glucosamine and various other  "joint" nutraceutical preparations.  However, chondroitin should not be confused with glucosamine.  Glucosamine appears to have some measure of efficacy for reducing pain and function (at least for the Rotta preparation....anyone know what that is?) , with possibly more of an effect in those with moderate to severe OA.   

 

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

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

Sep 15, 2007
Medford, NJ (USA)

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

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

Aug 17-18, 2007***
Davenport, IA (USA)

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

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

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

Evidence-based Exercise for the Management of Musculoskeletal Disorders

Jul 28-29, 2007***
Charlotte, NC (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

MyPTConnect Communities Now on the Evidence Express®!

Many of you have signed up for the Evidence Express® in recent weeks. If not, I would encourage you to start your free trial today. Many of you also regularly follow and participate in discussions on MyPTConnect. We have just added all of the public groups from MyPTConnect as subscription options in the Evidence Express®. Now you can follow the discussions from your favorite groups on MyPTConnect in the same single daily email! We have also added several other feeds from a variety of other journals within the last week. Be sure to check out your MyEIM Resource Center to check out the new content and update your subscriptions! Once you're subscribed, you can update your content selections as frequently as you like. Let us know if you have any questions.

John

Kudos to our partner PT Jobs.com!

Evidence in Motion and MyPhysicalTherapySpace would like to take a brief moment to acknowledge our partner PTJobs.com (see the job listings on the right side of our web pages) for taking the necessary steps to insure that their job listings do not include ads from clients who operate in referral for profit (RFP) arrangements. A policy that goes into effect next week makes it very clear that PTJobs.com does not accept job listings for positions in a practice if any physician has a financial interest in the practice and refers patients to an employed physical therapist or to a physical therapist who supervises an employed physical therapist assistant due to fundamental conflict of interest.

To be clear, we did not have to twist their arm for them to move in this direction. The policy has always been consistent with their company’s mission and values, and they are themselves actively involved in and support physical therapist owned practices. The issue was figuring out how to drill down to ownership interests during the registration process. They settled on a process by which potential clients would have to make the following certification during the resgistration process:

“I certify that no referral source (including any referring physician) has a financial interest in the practice that has the position that is the subject of this advertisement.”

Clients further acknowledge that their ad is subject to removal at anytime if it becomes clear that the client's status has changed or the certification was falsely made. Kudos to PTJobs.com for taking a strong position against RFP. If you're seeking to hire a physical therapist or are looking for an opportunity yourself, be comfortable knowing that when you post your ad or resume with PT Jobs, you're supporting a company whose interests are aligned with yours. Let them know you appreciate their stance by doing business with them!

Now if we could only get every PT educational program in the country to adopt a similar policy when it comes to setting up clinical education sites for their students. We should be able to go to a website and see very clearly which educational programs have adopted such a policy and those who have not. Please let us know if such a list has been circulated or already posted. Otherwise, we will consider posting such a list here, one that can be updated in real time if a program adopts such a 'no RFP' policy. We need transparency in this area. I'm afraid that many programs routinely collaborate with practices that do not serve the best interests of the very professionals the educational programs are supposed to be training.

John

Survey Reveals Most Satisfying Jobs - Yahoo! News

It appears PTs get a lot of satisfaction from what they do...in the top 3 overall, in fact.

They are definitely not singing the Stones song "Can't Get No Satisfaction", although sightings of Tim doing so in various venues with his "IT Band" have been reported.

Are you satisfied with what you are doing?    If not, realize most of your colleagues are,  so figure out what the problem is (practice setting, responsibilities, environment) and change things.  If it is professional staleness, a little EBP will go a long way for a long time.

Rob

Survey Reveals Most Satisfying Jobs

Source: Survey Reveals Most Satisfying Jobs - Yahoo! News

Another Arkansas?

It certainly is interesting that we are having a resurgence of interest in our Chiropractic Perspective blog entry.

It seems the Tennessee Chiropractors are attempting to follow the precedent established in Arkansas. Here is an article in The Tennesseean from Thursday April 12, 2007. It's called Therapist at odds with chiropractors. Though I hate testimonials, I think one of the patients of this particular therapist sums up a lot of issues at once with her quote. I cut out her last name for the purpose of the blog entry :

"Green Hills resident Laura A's back problems led her to Rebecca Lowe's practice for about two years. She knows about the bill and the amendment, which could affect Lowe's business. "I love my doctor. I don't want to trash a doctor, but I did have to call my doctor and see her if I wanted an order to see Rebecca. Why does a doctor need to tell me my back hurts?" [Ms] A said. "What would be the value of (physical therapy) if Rebecca couldn't have used manipulation? I had gone to chiropractors, but when they worked on me, I didn't get relief. It wasn't a long-term solution." [Ms] A said Lowe taught her to do stretches and learn to treat herself.  "Her whole goal is how can you get better and how can I make you better for life. It wasn't like how can I make money. She's in it for the passion she has for healing people," [Ms] A said. "She really has taught me how to not only get over the damage I caused, but how to prevent it again."

I think that about sums up a lot of issues - direct access, manual therapy, patient independence, etc, etc.

I found this article through EIM's great Evidence Express Service.

Any comments, especially from our chiropractic guests?

Huh?

As we pierce thru the maze of methods to try and get an extra 1.5% from CMS for voluntary reporting, we find a major glitch.  It is only available if you submit your claims on a HCFA 1500 or its electronic version 837.  Which essentially makes it only available for PT’s in private practice including those working in POPTS.

Makes great sense doesn’t it?  Don’t forget though that this is from the same cast of characters that have made hospital’s exempt from a cap, an exceptions policy that can be gamed quite easily by folks who were responsible for this absurdity to begin with (SNF’s), and a whole new way of defining “group therapy” and 8 minutes.

Larry