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PR that might work!

Wow, what a concept. Here are some news stories getting picked up from the APTA release on the benefits of seeing a physical therapist for knee OA (studies recently published in the NEJM).

1) Today’s USA Today - “See a physical therapist.”

2) The LA Times story urges consumers to visit APTA’s Web site to find a list of APTA member PTs. 

3) The LA Times story is also getting picked up by some newspapers around the country (ie, Baltimore Sun).

Kudos to Felicity and company at APTA. Still waiting on patients blackberry thumb and backpack syndrome to show up (along with kids with tennis elbow, 30-something's with osteoporosis, and kids looking for safe snowboarding advice)...the good news is that maybe we've been able to dump "backpack care" to the OTs (no offense Tom and Keith:))!

Beat the drum...you can have surgery, you can have drugs, or you can see a physical therapist.

John

Is This Referral For Profit?

RFP is always a topic that gets people’s blood boiling.  This post is not about debating RFP but trying to define it.

As I survey the PT landscape throughout the country, Physician Owned PT clinics (POPTS) is becoming a rather mature industry-it is abundant everywhere except the states where it has been mandated out of it.  Attempts to eliminate it, slow its growth, and regulate it out of business have failed.  Private PT’s are dealing with it in a number of fashions and unquestionably it has hurt business for private practices. 

From what I have seen, the proverbial “cheese” has moved though in a much greater fashion and growth rate to the following scenarios:

Hospital WeAreTheAnswer is a large health care non for profit system comprised of a merger between a traditional Catholic and Jewish system.  They have hospitals, freestanding surgical centers, imaging centers, labs, urgent cares, and medical office buildings.  WeAreTheAnswer employs physicians in large numbers.  These physicians include primary care and specialists including orthopedic surgeons.  The orthopedists are paid a base salary and a bonus determined by their productivity based on MGMA data.  The data includes the entire realm of the orthopedists contribution to WeAreTheAnswer including referral and performance for imaging, PT, lab, and surgery.  Although the doc doesn’t get performance bonuses directly from PT per se, the physician does benefit.

Hospital SmallGuyTryingHard is a single hospital with all facilities located on a small campus including a medical office that employs physicians and even an orthopedist that they recruited.  They control the physician’s practice by managing it including the directing of patients to their labs, PT practice, imaging, etc.  Their “control” is uncanny-few patients leak out of their system.

Are WeAreTheAnswer and SmallGuyTryingHard referral for profit?  Are the competing PT clinics just as disadvantaged as a POPTS?  Are the PT employees of such system ever going to be in an “autonomous” situation as described in Vision 2020?

thoughts? help!!

larry@physicaltherapist.com

Cricket and PT - Branding Woes

After a recent conversation I realize that there is an analogy that for me shows how it feels trying to communicate what PT is without a success brand:

Imagine going your friends, family and business contacts and try to get them to buy tickets to a Cricket game.  They have heard of it, have their own idea of what it is but, if pressed, have no idea of the reality of the game.  They would make comments like:  isn’t that like Baseball? (Same as – isn’t that like a massage therapist or a personal trainer?), Don’t know if I’d like it. (Same as I don’t think it will help my condition), Never been to a Cricket Game before so I don’t think I want to take the time. (Same as never been to PT and so why would I take the time if I am not sure what it is, or I can exercise on my own?)  What are the rules of the game? (Same as – I didn’t know that you could treat that, or I didn’t know you could do manipulation…), and they wouldn’t think to ask who is playing because one team is just like the rest given their perspective (they go where the MD tells them to with go or an MD just sends them to the closest PT). 

PT is like Cricket because we have no Brand in this country, the public has heard of us but has no true understanding of what we do.  I fear that our existence (with diminished benefits, higher co-pays and a state of significant undervalue in the market place) is truly at risk.  Do the powers to be at the APTA understand what Cricket really is?  If not then they have an opportunity to understand how the vast majority of the public, many physicians and almost all payors perceive PT.

Been to a Cricket game lately???  - Jeff

The Cure

or at least conceptually on the right track from this month’s Fast Company article by Peter Carbonara showcasing Geisinger Health System’s plan to fix health care.  The 3 hospital chain in central PA sets a fixed price for various medical problems.  They use checklists and EBP data-something this blog has promoted since inception.

Best quote on how to replace fee-for-service:

“….linked to ‘evidence-based medicine’ which simply means doing what clinical data say works, rather than relying on habit, hopes, or tradition”

Let’s hope this spreads much greater than just CABG patients that are featured in the article.

 

Larry@physicaltherapist.com

Business Opportunities Due to Non-Compliance

There has been a problem in the medical profession for years.  The problem can be substantially reduced with a very simple action.  For some reason, as a whole, medical professionals don't take the time to do what is necessary to reduce the problem.  Beginning October 1, 2008, Medicare will refuse to pay for the problem.  I'm talking about hospital-acquired infections.  Infections are probably becoming more and more costly due to bacteria becoming more and more resistant to antibiotics.

Unlike pilots, medical professionals are not required to comply to a checklist type of system.  Hand washing would be first and foremost in all patient handling or invasive procedures.  Because medical professionals do not have systems in place to force the desired behaviors to increase safety, there will be business opportunities to help hospitals reduce their infection rates.  New items that will be marketed to hospitals will be products (for example catheters) covered in a silicon film that mimics the shape and pattern of shark scales.  Apparently shark scales are resistant to bacterial growth (I have no idea since I've never been around a shark.)  Sharklet Technologies has been creating products to assist in improving infection control issues.  Will new products actually solve the problem?  Will hand washing still be a needed factor?

Why don't medical professionals always wash their hands?  I think it'd be more cool to have a little scan type device required to be used prior to touching a patient.  Have a design where patients could see the results and request a scan prior to any handling.  Scan your hands between 2 parallel scanners; if the alarm sounds, go back and wash!  The way things are now, patients and family members can't be advocates for themselves.

Do you wash your hands prior to treating any patient?

Photo by Fiona Ayerst via flickr

Selena

Yes Virginia, Even You Can Have Your Own Personal Ultrasound Unit

I am known for my horrible taste in Holiday gifts.  I would much rather fly the whole family to Montana for a week of skiing than exchange gifts under the tree. Also, I like gift cards and I give gift cards. Perhaps it was the "Chia Pet" and "The Clapper" I got some family members on that Christmas a decade or more ago that sealed the acceptance of the token gift card. 

This past week when a patient brought an ad for a home ultrasound device into the office, I began to rethink the gift card thing.  Why don't I just get everyone their own home ultrasound device for the Holidays.  According to the information on www.ultrasoundcure.com their portable ultrasound units are:

"radically changing lives and the professional therapeutic community. A low cost, safe, easy to use unit allows professionals to provide their patients with units to take home and use for the duration of the healing process. This means you can get your treatments 3 times per day, every day, instead of just a couple times per week. That's 10 times as often - 10 times the benefit - meaning a much less painful and more speedy recovery"

Sounds (that's a pun) like a nice gift for the loved one - doesn't it?  Just wait, if you order now you get more because:

"The units come with our naturally medicated ultrasound gel that, through the process of phonophoresis, delivers anti-inflammatory and pain relieving ingredients deep into the body. Together, the combination of phonophoretically delivered medications and regular ultrasound therapy provide incredible pain relief and speed the healing process."

Please check out the links above.  The website is full of a lot of additional information about how ultrasound and its healing properties can help athletes and those experiencing chronic pain. The units are priced at $99. This price is only guarenteed for the next week.  But wait, like the above quoted statements, the website also claims that:

"If you don't have your own Portable Ultrasound Machine, don't worry. All on its own, MendMeShop Gel is an effective therapeutic product when massaged directly into the skin. If you're curious about the difference between applications with and without ultrasound you can always visit your local physical therapist or chiropractor with your own bottle of gel. They should be familiar with our product and its application."

So help me out, I really wanted to get Larry, John, and Rob at EIM something for the upcoming Festivus season.  Should I go with the home unit and Bulgarian lavender infusion gel - or perhaps stick to the basic Starbuck's gift cards?  As always, I look forward to your comments. 

Do Physical Therapist Assistants Add Quality?

When a physical therapist utilizes a physical therapist assistant is the physical therapist assistant really an extender of the physical therapist?  Probably not.  Then again, the response to the question does depend on quite a few factors.  Was a physical therapist assistant involved more than 50% of the treatment time?  Does the location of practice where services are provided have state regulations that require onsite supervision?  Does the location of practice have state regulations that dictate PT/PTA ratio?

In 2006 Linda Resnik, Zhanlian Feng and Dennis Hart addressed whether physical therapist state practice acts had an effect on services.  Specifically, what predicted high physical therapist assistant utilization?  Were the number of visits per episode of care affected by service delivery?  Was the patient's reported level of function at discharge affected by service delivery?

Focus on Therapeutic Outcomes Inc. (FOTO) provided data.  The data from 2000 and 2001 included 395 clinics from 38 states utilizing FOTO.  High utilization of a PTA occurred 7.7% of the time within a final sample of 63,900 patients.  High utilization was defined as services provided by a PTA more than 50% of the time.  60% of the patients within this data were treated in a hospital outpatient setting.

State practice acts did not have an association with high PTA utilization.  A high ratio of PTA to PT on staff was associated with high PTA utilization.

High PTA utilization was associated with 2.0 more visits per episode of care.  State practice acts that required onsite supervision of the PTA were associated with 3.1 more visits per episode of care.  If there was a state practice act that regulated PT/PTA ratio, this was associated with 1.1 fewer visits per episode of care.

High PTA utilization was associated with lower discharge scores.  State practice acts with unspecified PTA supervision was associated with lower discharge scores.  (In FOTO, greater the discharge score the better the functional level.)

My gut reaction is that physical therapist assistants might not be valuable in service delivery if the goal is efficient and effective care.  Although the evidence is devaluing services provided by physical therapist assistants, the actual process of how a physical therapist assistant is introduced into the service delivery model hasn't been analyzed.  Is there a competency issue with physical therapist assistants (education/training), is there a process issue (how and when a PTA is utilized) or is there a combination of both factors that create a less valuable product?

Even though we are a small slice of the pie in health care dollars, as various stakeholders are analyzing costs and determining the value of our services, what effect will a high utilization of PTAs (>50% of treatment time) have on our future?

Selena 

Think yet again before knee surgery...the broken record for today's times

Lots of press will be forthcoming on 2 new studies (here and here) questioning the benefits of arthroscopic knee surgery in favor of physical therapy for patients with knee OA. Nothing surprising here, especially with high quality studies like this and this supporting the value of manual physical therapy and therapeutic exercise (among many others). Incidentally, the 2 new NEJM studies remind me of this study that was published back in 2002 (abstract here).

Any common theme here? How about "Go to a PT First". The same model that has been proven time and time again for back pain will work for knee OA as well. It sounds like a broken record, but you can have surgery, you can have drugs, or you can see a physical therapist. It wouldn't be all that difficult if health care had something to do with the patient's best interest. Sounds like the AOSSM needs to get together and for the knee surgeon's version of the Association for Ethics in Spine Surgery. Not trying to paint with a broad brush here (there are good orthopaedists out there who appreciate the value of high quality non surgical management), just that if history prevails, it will be about 15 years before we see practice catching up with evidence.

The best days for PT remain ahead. How long will it be until someone other than our profession recognizes this?

Your thoughts?

John

Minneapolis Front Page News: For companies courting surgeons, how far is too far?

Minneapolis Star and Tribune Medical Technology Reporter Janet Moore has three very interesting pieces in the paper this week.  The first from Sunday's front page is titled "Part I: Medical device payments to doctors draw scrutiny" and highlights the issue of local University of Minnesota Spine Surgeon Dr. David Polly and the $344,375 in consulting fees Dr. Polly allegedly received from Medtronic in 2006, and similar amounts in 2004 and 2005.

This has all come to light because of a complaint filed in this whistleblower lawsuit filed by two former Medtronic employees in U.S. District Court in Massachusetts.  The Massachusetts lawsuit accuses Dr. Polly and 112 other leading spine surgeons of allegedly accepting a total of $8 million in unethical and possibly illegal consulting payments in 2006 alone.  The lawyers for the physician defendants have provided a response here.

Today (Monday), Ms. Moore presented an article on the lawsuit itself and asking the question how far is too far for leading surgeons to accept financial compensation realted to medical device use. 

In addition to the information on the lawsuit, the articles also highlighted the Association for Ethics in Spine Surgery or AESS.  This organization's purpose on their webpage is to:

"promote patient care and evidence-based medicine and to provide increased public awareness of the detrimental and pervasive financial influence of industry on many health care providers and patients. The Association for Ethics in Spine Surgery promotes the care of patients absent of any consideration of financial gain or loss based on choice of surgical equipment, implant, manufacturer, hospital or surgery center. AESS members practice informed consent and believe patients have a right to know if their doctor is a paid consultant or distributor for any manufacturer or product." 

The AESS website provides a nice list of media and news links related to this issue as well. The third and final piece in this series will appear in tomorrow's paper. 

I look forward to your thoughts and comments. 

JW Matheson DPT

Health Care Reform...

Based on depressing accounts like this of yet another drug scandal, I am not counting on the pharmaceutical industry to provide much assistance in reforming health care. Remember, when it comes to managing musculoskeletal conditions, you can have drugs, you can have surgery, or you can have us. Never apologize for being a physical therapist. Our potential to be positive agents of change in health care reform is immeasurable. The perfect storm supporting the value of PT is brewing...evidence (it's on our side), aging (anyone notice we're growing older as a population?), and the current crippling of our health care system (musculoskeletal = #1 cost). We too frequently get wrapped up in all the negativity around the barriers, yet whether we realize our potential is completely in our control. The opportunities are staring us in the face, and our best days remain ahead so long as we don't get in our way.

John