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This is but one and really should be called-P4C-Pay for compliance and has been the most common. This blog has been down the P4P trail many times and our continued pessimism is still strong. At least you got to hand it to the authors of the name: BTE Medical Home Program. Very intuitive.
Dr. Wes analysis is right on target.
When I first started blogging, I thought about every post being titled after a song of my favorite artist, Bruce Springsteen. I abandoned the idea quickly after realizing his proclivity for songwriting is more than mine for blog authoring.
However, I couldn’t help think of this song as I tossed many recent PT magazines down the trash. Side note: Bruce performed this song that he didn’t write (that would be Young Paul )on the Sessions Band Tour and you can hear it live on the Live in Dublin DVD). I tossed them into the trash simply because they did not represent the “common people”-what our industry does on a day to day basis.
While carrying the private practice PT magazine, PT the magazine for PT’s, and the various “wouldn’t wrap a dead rat in” throw away non-APTA journals, the content on PT as a “cash” business was dominating-grossly over representing our industry.
I realize that there are the “chosen” few who have a cash based business typically surrounding a niche and often times not even really being a PT practice (e.g. Pilates, fitness, etc.) per se but to deceive the mass plankton like ourselves that this is either a megatrend or the wave of the future is both foolish and damaging to our profession.
It is foolish because the market has no pent up demand for cash paying elective PT services. “Concierge” medicine is a microtrend simply because there is an inability to access primary care docs in some markets and there are some people willing to pay a premium for it (certainly not “common people”). PT practices around the country aren’t suffering due to lack of ability to access our services, they are suffering because of the hi cost of co-pays in some markets coupled with declining reimbursement, increased cost of doing business, unkind regulatory environment and encroachment. Is it realistic to think that we will be abandoning a third party reimbursement schematic anytime soon?
It is damaging to our profession because it further “clouds” the picture of what we do and who we benefit the most. While there is little to no consumer demand for cash payments to traditional PT clinics, there is a pent up demand for people suffering from musculoskeletal injuries who would do well to access a PT where we have demonstrated cost effectiveness and efficacy. If only more people knew about this-there’s the marketing and branding challenge.
For those of you that have a cash based only business-congratulations and please consider yourself fortunate. I am sure that you are more in number than blackberry thumbs treated by PTs but the rest of “common people” have too many other things to worry about in this industry and don’t need to be overwhelmed with the misrepresentation of your prevelance and viability in our journals.
Thoughts?
"Some of the nation’s most prominent spine surgeons hailed it as a medical breakthrough..."
It turns out, that was because they were not only surgeons, but investors as well...investors reluctant to disclose financial conflicts of interest to the FDA. This is making headlines in the NY Times. Device manufacturers and orthopaedic surgeons: one can't live without the other, I guess.
ERIC
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This post Larry sent around via email yesterday is related to Tim's recent post regarding
recent challenges as to whether cholesterol plays a key role in heart disease.
The only thing that is virtually certain in health care these days is that costs are way up, quality is down, and that diagnostic uncertainty is everywhere. In listening to the political debates in recent weeks, it is apparent that candidates on all sides of the political spectrum have grasped the notion that our health care system is too expensive. What we don't hear much about is the quality chasm or the huge conflicts of interest that exist in Big Pharma and medical device industry serving only to increase profits and drive up costs for drugs and diagnostinc testing that in many instances causes more harm than good. I don't pretend to hold all the answer for our health care system's crisis, but I am fairly certain that the optimism for a system that completely sources medical decision-making to the "patient-doctor relationship" is probably not justified if past performance is any prediction of the future.
This quote from Niko Karvounis on the Health Beat Blog sums it up well:
"We need to remember that, no matter what we are promised, uncertainty is ubiquitous in medicine. Patients don’t always want to hear this. They trust in medical professionals. They trust in procedures. They trust in the capacity of innovation to make their lives better. And they should—but for our health care system to work, those in whom we trust must be committed to efficacy rather than innovation for its own sake. The focus needs to be on what should be done, rather than what can be done. The two are not the same, no matter what medical prognosticators would have you believe."
John
The Orthopaedic Section recently announced proposed changes to the eligibility criteria necessary to sit for the OCS board-certification exam. I suspect it will generate much discussion and debate in the coming months. Please take the time to respond should you be invited to complete the survey that is mentioned.
It's past time for us to take the next big step towards incentivizing residency training post graduation from PT school. Our current criteria of 2000 hours of general practice in an orthopaedic setting are insufficient to establish any degree of face validity in our health care system that equates board certification as being something achieved post residency training (translated...tough, lots of sweat, late nights and weekends, stressful board exams, etc.). We know that we will have matured as a profession when 95% of our graduates complete residency training similar to medicine. It's clearly must be the "next big thing" in a post DPT world, a rapidly evolving profession, and skyrocketing demand for our services.
By the way, please don't ask whether completing residency training will immediately translate into higher compensation. Our value in the health care system is determined by fee schedules, which is largely driven by our brand and the relative perceived value of our services as determined by 3rd party payers (currently PT = black hole of disparate services provided with complete inconsistency). Therefore, none of this will lead to immediate changes in compensation, nor does having a DPT or residency training itself make you immediately deserving of a high salary. However, standardizing our training around a medical model with legitimate post graduate residency training that is so common you wouldn't seriously consider practicing as a physical therapist without it (and no consumer would want to see a non board certified PT), will go a long ways in improving our brand, differentiating physical therapists as experts in managing patients with musculoskeletal conditions. PT compensation will adjust upwards once we lay claim to our brand and become recognized as legitimate health care providers (think "Physical Therapist", not "physical therapy") that deliver value for improving health.
If you're in doubt, just ask yourself when was the last time you got referred for "medicine", "dentistry", or "optometry"? No, you get referred to a physician, a dentist, or an optometrist. We can mark our arrival when patients are referred (or better yet think to see their physical therapist instead of a primary care provider or physician specialist) to a physical therapist vs. physical therapy. Residency training is an important step forward to that end. Looking forward to everyone's thoughts.
John
This recent "guideline" on PT published in American Family Physician is another scary reminder of the branding issues we face as a profession. This reminds me of Mark Schwall's recent comment to this post begging for the insanity to stop regarding perceptions that "physical therapy" is actually a treatment. I liked what he had to say and pasted his response to the previous post because it applies perfectly to this article:
"When will the insanity stop? Physical Therapy is a profession not a treatment. What these badly titled articles demonstrate is that a "Physical Therapy" treatment does not work maybe. This is no different that saying "Medicine" doesn't work for treating angina when the treatment was prescribing Pennicillin instead of Nitroglycerin. We (Physical Therapists collectively) are as guilty as anybody in our generic use of the term in communications.
Ok everybody say after me "Physical Therapy is a profession not a treatment, Physical Therapy is a profession not a treatment...."
Similar to the sciatica paper, this "guideline" further erroneously brands PT as a grab bag of interventions to be randomly applied in a "prescriptive" manner based on the whim of a physician, most of whom have little to no clue as to the real identity of a Physical Therapist.
John
Change is hard. Gary Taubes has an excellent editorial in todays NY Times that does the unthinkable of challenging the medical establishments idea that cholesterol plays a key role in heart disease. It is a fascinating piece that looks at the recent evidence that the combo drug Vytorin had fared no better in clinical trials than the statin therapy it was meant to replace.
Right after I finished reading the piece I got an email from one of my students that goes something like this... I continue to get resistance from my CI to using spinal manipulation in LBP management. I think the best I can do is just teach by example, observe, and only offer information when asked. I feel that my CI though apparently knowledgeable is not receptive to my sharing of EBP in the clinic. He has read the more recent manipulation papers but that has not convinced him to change. I don't know if he is just afraid deep down, because maybe the current literature supporting the manipulation techniques that we have learned in school is enough to "get the patient better" and that the techniques from the various certification courses are not necessarily needed or the BEST to obtain clinical success.
Hmm...change is hard. It's a drag when the evidence doesn't match our well intentioned theories. Why are some folks resistant to change and others embrace it?
Tim
I've often opined about the lack of Physical Therapist presence in the blogosphere. Earlier this month I issued this challenge and a call for PT's to become bloggers.
I'm happy to report that a few took up the challenge and we now have more than 3 PT-penned weblogs! No small feat, as committing to a solid blog is a significant undertaking. You need to be brave enough to write what others might see, tech-savvy enough to design a nice page, and dedicated enough to post regularly.
Now, before I offer an introduction to your PT-penned blogs, I must issue another call to action. You see, blogs need readers. More than that, they need subscribers. Thousands of people read the Evidence in Motion blog, but surprising few have subscribed to these other PT related blogs. My call to action then becomes a call for you to go visit these blogs, subscribe to the feed (or e-mail subscription if you must) and support your hard-working, brave colleagues!
Yeah, I'm including my blog, NPA Think Tank (recently featured by TypePad) in this list of blogs that would love your subscription support as well.
As an aside, you will notice that all these blogs are written by men, leaving Rachael Lowe's Physiospot Blogs as still the only one hosted by a woman (although we should point out Selena Horner's posts here on EIM) in this largely female profession. Ladies: Join in!
Check em out!
A student-penned blog written by Johnny May. This blog is a well-written glimpse inside the profession from a student's perspective. But you may find Johnny is more than a student, he's an entertainer as well.
Written by Jason Harris, who should be complimented for his use of the new BPR3 blogging standard when presenting posts on peer-reviewed research.
The Physical Therapy Etcetera Blog
Mark Schwall wants to tell you about Zotero, among other physical therapy related news and topics, etc.
So there you have it. If anyone needs any blogging advice, I'm always available. Contact info can be found on my page.
ERIC
Good job for painting a real picture of what's going on in our world! Physical Therapy Clinics Feeling the Pain
Healthsouth and Physiotherapy Associates besides being corporate-model clinics had issues and ramifications incurred for their day to day operations in some of their clinics. I'd think it would be difficult to survive with imposed fines/penalties combined with a large change in day to day operations to be within rules and regulations which would substantially reduce projected revenue especially with the current state of dwindling reimbursement. (Stryker and Physiotherapy Associates issues... right, sloppy paperwork )
