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Larry beat me too it!
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Larry beat me too it!
or at least they are trying to be. The gems from MDPTpartners are now resorting to mass emails to try and lure unsuspecting PT’s into their POPTS game. You just have to love their Major Headlines-“You possess and industry called physical therapy that you are not being compensated for. Let’s change that today!!”
How they got tons of PT’s email addresses is beyond me but test assured I have little confidence in their “unsubscribe feature”. Their ending email blast includes this bizarre note:
TAKE ACTION - Doug recently told me a shocking statistic. His average telephone conversation with a physician is 15-20 minutes with 90%+ ending in an agreement to move forward. His average conversation with a PT is one hour with 50% actually doing something within a month. The problem is that the physician tells Doug whom he wants to work with so by the time the PT has finally decided to move forward, the physician has a contract and is seeing patients, your territory is taken and you are shut out. I urge you to take action to assure a secure and profitable future.
I haven’t seen a sham this good for PT’s since some unscrupulous PT’s in Kentucky as a method to affirm their credibility while soliciting doc deals formed the Ethical Physical Therapy Association which sounded legit to many docs looking to make a few benjamins in the PT business.
Although there are many outside of the PT world doing the same thing, it should be duly noted that these are PT companies aggressively seeking doc deals.
Comparative effectiveness can reach into so many different areas than just surgeries or medications. We are all probably familiar with the 1998 Cherkin study comparing physical therapy, chiropractic manipulation and a booklet for low back pain treatment options.
After coming back from the Combined Sections Meeting, I caught up on a lot of reading/skimming of various materials. Eric already mentioned the lack of wireless, so I won't say any more.
I read something that obviously hit a nerve with me because I need to share my thoughts.
"Foot orthoses were similarly effective as physical therapy for patellofemoral syndrome, but combining the 2 interventions was no more effective than either alone."
I had to review the source of this statement. Thomas McPoil was one of the authors. I was interested in what was defined as "physical therapy."
"Physiotherapy consisted of a combined therapy approach that has proved efficacious in patellofemoral pain syndrome and included patellar mobilisation, patellar taping, a progressive programme of vasti muscle retraining exercises with electromyographic biofeedback, hamstring and anterior hip stretches, hip external rotator retraining, and a home exercise programme."
At first glance it appeared reasonable... but... doesn't research seem to indicate that the better a patient is classified, the better the outcomes? It appeared that everything but the kitchen sink was thrown at these patients without any thought into individualization. In the November 2008 Journal of Orthopaedic and Sports Physical Therapy, Carina Lowry, Joshua Cleland and Kelly Dyke described multimodal management of 5 patients with patellofemoral pain syndrome. Interestingly, each patient did not receive orthotics nor did each patient have patellofemoral taping nor did each patient perform the same stretches. Manual intervention to the hip and lumbar spine was also provided depending on the evaluative findings of each patient. This particular case series brought regional interdependence into the treatment equation.
I thought maybe the lack of classifying each patient was a design problem. So... what could I find on classifying patellofemoral pain syndrome? In 2005 Witvrouw et al. classified non-operative patellofemoral pain syndrome in Knee Surgery, Sports Traumatology, Arthroscopy. They seemed to ignore regional interdependence, in particular the hip and the lumbar spine. The article had one very, very small mention of dynamic activities such as single leg squats, and ascending/descending stairs. The dynamic activities weren't even included in their figure diagramming their proposed classification scheme. For sure, the work of Powers et al. wasn't included. It appears to me that the only recent published classification system that I could find, wasn't adequate in really subgrouping patients into a treatment based classification system.
What struck a nerve with me was that the article was highlighted as "Medscape Best Evidence." Best evidence? How can that be without a real control? Sure, the study took on a multimodal approach, but there was little thought as to whether every piece of the approach was really needed with each patient. I'd be more interested in the findings if the design included a real control and instead had the physical therapy aspect more in line with what Lowry, Cleland and Dyke described.
So, now there are physicians and possibly third party payors that are believing that a pre-fabricated foot orthosis (with or without some alterations) is just as good as receiving physical therapy services for patellofemoral pain syndrome. Physical therapy services will be viewed as a costly alternative that provides the same results as a prefabricated orthosis. Nice....
So, how do we position ourselves to address these types of situations?
photo by pomoyle via Flickr
~Selena
Outstanding work to some students in Regis University's tDPT program...Rich Westrick (ask to be Rich's friend on FB...very loyal and even has some great lip sync video from Iraq.:)), Ernest Gamble, Janette Graham, John Kangas, and Robert Swayze. This is exactly the type of viral marketing that is done on the cheap but with high impact....the ultimate definition of value add.
Kudos to Regis for having students prepare this type of direct to consumer marketing material together. Be sure to check out some of the submissions from the recent EIM Elevator Pitch competition if you haven't already...same concept with some very good submissions.
John
On Feb 23, HR 1137 was introduced. Otherwise known as Athletic Trainers’ Equal Access to Medicare Act of 2009 which would amend title XVIII of the Social Security Act to provide improved access to physical medicine and rehabililtation services under part B of the Medicare Program.
On Feb 17th, AAOS issued a press release based on a few studies predicting a shortfall of orthopaedic surgeons due to the huge increases in joint replacement procedures.
Should PT’s introduce HR XXX: Physical Therapists Equal Access to Medicare Act of 2009 a bill to amend social security to provide improved access to orthopedic services under part B of the medicare program?
Perhaps instead of fighting HR 1137 we should be more creative by introducing a bill of our own!
In today’s WSJ, heart disease which is the most studied illness in all of medicine only has 11% of more than 2700 recommendations supported by “high-quality” scientific testing.
About half are based on expert opinion.
I can’t imagine what percent LBP research is based on.
All of this emphasis should help those that have integrated EBP into their clinical practice-there will undoubtedly be patients asking for it and in fact “evidence based world” may soon replace “bailout”!
Ingenious, no, fun, you bet! We all need to laugh a bit more.
Have other issues, themes, thoughts that I might be able to have a bit of fun with?
David Straight, PT
From Garry Trudeau’s Doonesbury, and as read on the Evidence Soup blog, the 30 Jan 2009 cartoon has officially declared in a manner only fit for Doonesbury. Here is an excerpt:
Can some ingenious PT out there change the cartoon’s characters to be reflective of the medical world?
larry@physicaltherapist.com
"Designing for Better Health" ... "demonstrate innovative solutions around financial transactions for social change"
A competition that focuses on innovation, social impact, and sustainability.
I don't know what anyone else thinks, but merging the incidence and cost of low back pain with this video
and adding Virginia Mason Medical Center data/outcomes of putting physical therapists first might be a first step in sharing the skill/knowledge and cost-effectiveness of physical therapists with people outside of our direct network. This isn't about winning prizes or money, this is about physical therapists being a solution to assisting with healthy living.
People with chronic low back pain aren't "living" a quality life and are not always making the best decisions in their care. Are medications, multiple diagnostic tests, injections and surgery the most "healthy" options for someone with low back pain? Physical therapists ARE an innovative, less risky, less costly option.... One day, maybe physical therapists will not be considered an innovative solution because physical therapists WILL be the best first choice, but for now to change the current structure = innovative.
What do others think? Anyone game on entering an international competition?
~Selena
2009 might have an exciting twist of events for Washington State. I hear Washington and I think "manipulation issues." One physical therapist owned practice has been battling with a physician owned practice for a few years. This just might be the year where it is settled once and for all if physicians can own physical therapy clinics in the state of Washington.
The American Medical Association shares a few ongoing scope of practice issues in its resource center. The first is a question of whether orthopaedic surgeons in the state of Washington can employ physical therapists and refer to their own physical therapists. This question began back in 2006. This is now an issue to be resolved by the Washington Supreme Court. It may be resolved in the fall of 2009.
The second is whether a physician may bill for physical therapy services in the state of Kentucky. Case # 2007-SC-000756 involves the Kentucky State Board of Physical Therapy and Dubin Orthopaedic Centre, PSC. If you search for this case # here, you will see that this has been a long battle since 2006 also. The American Physical Therapy Association and the Kentucky State Board of Physical Therapy have each provided attorneys in this particular case. Dubin Orthopaedic Centre, PSC has its own legal representation along with legal representation from both the American Medical Association and the Kentucky Medical Association. This issue will be resolved by the Kentucky Supreme Court.
I tend to believe the reason the American Medical Association is involved is because these issues, settled by a supreme court, could impact more than just the state in question. 2009 or 2010 may bring change....
~Selena
