Playing By The Rules
“Insurance Company Rules” that is. My favorite topic.
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“Insurance Company Rules” that is. My favorite topic.
Maggots for wounds... leeches to improve blood flow.... AND garra rufa for psoriasis.
Ichthyotherapy with short term ultraviolet A
The garra rufa don't seem to be popular in the United States for psoriasis. Some salons are beginning to have these little nibblers for pedicures.
For a video of the little ticklers in action.
Selena Horner
Maggie Mahar presents a provocative piece on how "Medicare could pave the way for national reform."
The article presents some compelling illustrations of how Medicare can fix their ways and be an example of how national reform might proceed.
I want to take a look at the concept from the perspective of the autonomous PT.
The article discusses how the next administration should "address the structural problems that undermine the laissez-faire chaos" we currently have in place. I agree! Medicare has imposed some ridiculous structural "rules" for the delivery of physical therapy services. To make matters worse, there is no real statement about what care is delivered, just WHO delivers the care and the fact that they need a stopwatch!
Ms. Mahar notes that "health care prices continue to climb without a concomitant improvement in patient outcomes or patient satisfaction." Well as far as PT practice goes, both Larry and Selena have already given great illustrations of how ridiculous rules for care delivery in physical therapy do not improve the "quality" of care delivered, maim the autonomy of the physical therapist to choose their care team and increase the cost of the care delivered! If you have silly rules that force one to one delivery of care care rather than embrace evidence, innovation and efficiencies then your costs will go up without a "concomitant improvement in the patient outcomes or patient satisfaction!!"
The article goes on to note that MedPac has called for an independent and unbiased "comparative effectiveness institute" that would compare new cutting edge treatments and procedures. Again, I agree! All I can do here is recant my favorite Tim Flynn quote (he has other great quotes as well, but this one is SFW): "You got surgery, drugs or us!" Seems to hold true! Please, please, please compare physical therapists treatment for LBP with other treatments such as drug therapy or surgery.
By the end of the article, I start to really like Maggie. To quote:
"The notion that more care—and more expensive care—is not better goes against some of our most deeply-held assumptions about medicine and medical technology..... decades of medical research shows that less aggressive, less intensive care leads to better outcomes."
When your back starts to hurt give us physical therapists a call Maggie! You seem like a practical gal......
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How many people do you treat or happen to see wearing flip flops?
They are worn in weddings, on bikes, on motorcycles, indoors, outdoors, in stores, on beaches, and probably even in the clinic!
Earlier this year during the American College of Sports Medicine Annual Meeting, Justin Shroyer presented findings that indicated wearing flip flops alters the biomechanics of walking and increases the risk for lower extremity injury.
I wonder if a Flip Flop Fiasco could win a Bulldog Award?
photo by karenhdy’s photostream at Flickr
Selena Horner
After reading the umpteenth similar press release on the crippling effects of medicare reductions on the PT world, I thought I would point out something-regardless of whether Bush vetoes the bill (he will) and then it is overridden (it will), medicare rates are going to go down regardless-here’s why.
The funding for the elimination of the reduction is based on re-financing medicare advantage plans. These plans are either paid higher than the government can do it themself by roughly either 14% for the HMO type or 17% for the FFS type. The FFS type was only supposed to by a temporary plan to entice medicare folks to go into private medicare but for reasons only best understood by folks who also understand farm subsidies, FFS additional payment has not gone away. Under the new payment terms by medicare (to pay them the same rate as CMS), it will be gone.
Which brings us to the reason why our rates will go down. Medicare Advantage plans will begin to substantially decrease payments to providers in order to “survive” (keep in mind survival to an insurance company means millions in stock options to the CEO). Many Advantage plans were already negotiating heavily with providers for below CMS rate plans even under their premium payment by CMS. Of course, educated readers of this blog would never accept below CMS rates-hopefully they continue not to accept but if history is any teacher, many will cave to below CMS rates.
It depends. Does the individual have metabolic syndrome?
Researchers recently published a study comparing the results of aerobic interval training, moderate exercise and a control for individuals with metabolic syndrome.
Doing interval work at 90% of maximal heart frequency seemed to be the ticket for resolution of metabolic syndrome in 46% of the subjects randomized to the aerobic interval training group.
It doesn't appear that Wiihabilitation is an appropriate recommendation for these individuals.
Selena Horner
Senators couldn't have missed ALL the turmoil that is speculated to occur if HR 6331 is vetoed.
The AMA not only has a video that begins streaming as soon as one visits the website, but has a link on their home page for information on Medicare participatory options for physicians. The American Medical Association became a member of YouTube on July 1, 2008 and shared their video. The AMA created an ad targeting Senator Sununu which was also found on YouTube with almost 2,000 views in a week.
When my husband called me from Texas the other day, he mentioned reading a large article in the New York Times about the negative impact this bill would potentially have on Medicare beneficiaries.
The AMA surveyed almost 9,000 physicians on the impact a 10.6% reduction in the fee schedule would have on their practices. Grandmas will definitely have a more difficult time obtaining medical care. I'm not sure how many Medicare beneficiaries there are, but I'll assume about 44 million. That's a lot of Grandmas that won't have very many options.
Now the Senators seem to be aligned with supporting the Medicare Advantage programs. Senators are failing to recognize one obvious detail. Generally speaking, the companies (Humana, UnitedHealth, Blue Cross) that offer Medicare Advantage programs are not solely dependent upon the Medicare Advantage program and have a whole slew of health care packages for employers/subscribers. Without the financial support from CMS for the Medicare Advantage product, those companies will continue to experience large profits overall.
Today, I hope the Senators can say yes to Grandmas and no to greed.
Selena Horner
What will be the ending of the legislative saga?
The current legislation without any additions or changes means that every physical therapist participating with Medicare will have to continue with whatever happens until December 31, 2008.
Both the APA and the AMA took steps to communicate to their members the options available for their members and the interpretation of those options and some assistance in implementing those options.
I wonder what physical therapists will collectively be thinking in November 2008? Will access to physical therapy services for Medicare beneficiaries be affected? It probably all depends on the final chapter of the legislative saga.
Selena Horner
Can Chairman Baucus include in his letter some other stuff like getting rid of plan of care, physician referral requirement, explicit provider list, inconsistent supervision between part A and part B?
Can Baucus remind them that outpatient PT is less than 2% of part B budget and is the only medical service that went down in real dollars (not the make believe government decrease from increase one’s we always read about) between 2004 and 2006 per their own data? This is despite the fact that more beneficiaries were treated than the prior years.
Can’t we get a little pay for performance via some relief from the very regs that are putting freestanding outpatient clinics under huge financial strain and compliance pressure trying to determine if their manual therapy intervention is group therapy or not?
Will Secretary Leavitt throw Baucus’ letter away like he did mine.
Does government really run this way? First, hold our claims. Second, clarity on caps/modifiers and now, hold the phone caps might be cleared.
Anybody for Gov’t run universal health care?
