What's Next Physical Therapy Clinics in Toys R Us?

I am normally an upbeat optimistic guy-probably because I seldom watch the news and the news that I read is in RSS chunks.  However, pessimism has prevailed recently in the PT news department.

First we had our hoola hoop experience.

Then we had a “proactive” PT group that believes PT’s sole purpose is home exercise programs and is so “concerned” about co-pays that they are posting their exercises so that patients can come in for fewer visits.

And, just when I thought it couldn’t get worse, we now have Wii games in rehab clinics which appeared in USA Today).  Wonder who wins between the PT’s and OT’s?  (BTW, please send me the CPT codes for the golf game which is my favorite).

Is there any wonder we have credibility problems?

Thoughts?

Larry

Comments

[Selena Horner]

Larry, I agree with you in regard to the free home exercise programs. I hear and understand the position that the therapists chose but there could be a better option that maintains value to our services - even home exercise programs. A better option would be to have the programs password protected, emailed, or copied onto a disk or memory stick for patients. The choice made by those therapists severely devalues our service - high copay, low copay or no copay.

On the Wii matter though, for the right patient, I see Shepherd and Carr and motor control and motor relearning all over it. For the right patient, how awesome to have immediate feedback, a way to mix in weight shifting and control of center of gravity combined with peripheral extremity activities that require coordination, timing, acceleration and deceleration control, recruitment patterns within the whole extremity and force production. The only question using the Wii begs is whether functional activities do improve (sit to stand, in/out of car, bed mobility, ambulation….) because of the lack of specificity of training.

[Carina Lowry]

Well Larry,

There are quite a few CPT codes that could be billed under your golf game...let's see first we will need to evaluate whether your inability to play golf is a disability--code 97001. If you are indeed a professional golfer, then yes this would be a functional retraining task (code 97530) or we could work on neuromuscular reeducation of your swing and make sure you are balanced (code 97112). Yet again if you are having back pain, we could use the swing to work on rotation with therapeutic exercise (code 97110).

Of course all of this is said with great jest. I can truly see your point however I wonder how many clinics out there are billing as such? I do know of a few clinics that specialize in the niche market of golf analysis and do quite well as an adjunct. But...shouldn't we stick with our bread and butter and just make better bread???

Carina

[cTimothy]

Larry,

You may take comfort from the fact that you are in the vocal majority in the issue of free YouTube videos of physical therapy home exercises.

Many, many physical therapists have expressed concern that free exercises will 'devalue' their work. One common refrain I hear goes along the lines of this, "The price charged is the value people assign a good or a service". The implication is that a free video is essentially worthless.

Feedback from the consumer side is, however, uniformly positive.

It is the position of Medical Arts Rehabilitation, Inc. that the consumer is in the best position to determine what is in the consumers' own best interest.

Larry, there are, at any one time, up to 46 million Americans with no health insurance and no access to your services. There are millions more underinsured who elect not to consume your services and mine because of time costs and money costs. The American healthcare system has failed these people.

Larry, free YouTube videos change the dynamics of the delivery of physical therapy services in a way that increases access to physical therapy services and may increase the health of Americans.

YouTube and other technologies can change the game in ways that are positive for Americans and positive for the physical therapy profession.

I encourage every physical therapist to put your knowledge out there. It doesn't have to be free and it doesn't have to be on YouTube but you do have to get it out there.

We deserve to be in charge of the public perception of physical therapy.

I've encountered some resistance, mainly from the profession, on this issue of free YouTube videos.

I think electronic media in general, and YouTube in particular, is an incredible opportunity for the dissemination of physical therapy exercise knowledge.

Just like the advent of toothbrushes and dental floss increased awareness of and demand for the services of dentists, I think my YouTube videos (at www.MedicalArtsRehab.com) will broaden the whole market for physical therapy services from physicians to patients to payors.

I welcome your comments.

Sincerely,

C. Timothy Richardson, PT, MTC

Medical Arts Rehabilitation, Inc.

'Get Better Physical Therapy'

timrichpt@yahoo.com

[Rob Wainner]

Tim,

I think most people empathize with the position of consumerism in general, mostly because we are all consumers.

However, the position of Medical Arts Rehab., that the consumer is in the best position to determine what is in the consumers' own best interest, has one significant problem....we are dealing with health-care consumption here and not chocolate or fashion.

While the consumer is in the best position to tell the a health-care provider what their symptoms are, it is incumbent upon the health-care provider to come up with the best treatment options from which the consumer can then make an informed choice and the health-care provider can then monitor the patients response.

Yes, lots of people are uninsured and we have a ton of problems with health-care in general. But please don't use that as an altruistic explanation for trying to make a dime, drive traffic across your web-site, or make your mark in any other fashion with the U-Tube exercise video approach. As it stands, we now have one more bit of noise patients have to wade through to figure out what real physical therapy is. This approach to exercise intervention, by the way, is not physical therapy but more akin to personal training....if a patient has a specific complaint then only a physical therapist who has interacted with the patient can provide interventions that would constitute physical therapy care.

Rob

[Selena Horner]

Tim, I don't believe a free video is worthless.

The biggest issue with having free physical therapy home exercises on YouTube that can be found by the general public is that you have chosen to devalue your knowledge base. The public perception that you are actually facilitating is that if the person does a few generalized home exercises the complaint or problem will be resolved. YouTube does not increase access to physical therapy services. Physical therapy services entail a whole lot more than just a home exercise program. Home exercise programs are one small aspect of physical therapy services. Without physically evaluating a patient, screening a patient and determining that physical therapy services are truly indicated and red flags are ruled out, how exactly is the public safe? Is research actually indicating that exercise alone provides the best functional outcomes?

What if a patient had shoulder pain and stiffness and searched YouTube videos and just happened to find your physical therapy home exercise videos that indicated shoulder pain and stiffness could be reduced? Now take it hypothetically to the worst case scenario - the patient had a metastatic adenocarcinoma of the lung and didn't know it? Who would be responsible for the patient's erroneous perceptions that a home exercise program for a shoulder that was stiff and painful would resolve the issue? The free information available to the patient may definitely not be the answer to the patient's problem. What was available definitely wasn't in the best interest of that consumer.

From both a physician and a payor perspective, again, you are creating the image that the whole physical therapy service package isn't necessary, is costly and a physical therapy home exercise program can resolve the issue. It's kind of like short-sheeting a bed, the only difference is what you are doing really isn't a joke or funny.

Why not put the value into your service? Remove your videos from YouTube. Have the videos on your site but have them password protected so that patients you evaluate have them available to use as needed and the general public remains safe. If a person tries to access you videos without a password, you could have a nice little pop up that politely educates the person that for his/her safety it is best to be evaluated by a physical therapist to ensure that physical therapy services are appropriate.