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A Rally For a Better Strategy-Questions, Questions

While only 603 participated in a virtual healthcare rally done by APTA, it is certainly a good start and a unique way to get the troops corraled.  It is also laudable that the collaterals and position of PT perspective in healthcare reform have been published. Unfortunately, they provide as much excitement as the fine print on a mattress tag.

We have documented in the past that what is missing from these efforts is the advocating for the wrong audience.  Reform is supposed to be about addressing societal needs. 

While I acknowledge that I have more questions than solutions for these complicated issues,let’s get some strategic thinkers, marketing experts, and PR folks engaged in the content development and it's presentation.  As PT's, we can’t hang our hat on a host of legislative success in recent years-particularly the big issues like direct access in medicare which is going on approx 10 years and the eliminating the medicare cap which has probably been around longer than fax machines. So how about a different approach?

Some questions:

Why instead of writing in language clearly meant for lobbyists and healthcare wonks don’t we write something that every American can understand and something that resonates with the day to day patient care lives of PT’s?

Why is wellness and prevention the highlight and apparently the priority?  How many PT’s actually do the example cited in the document of “for patients who are obese, physical therapists develop programs that can balance the progression of exercises with the need for joint protection and safety”?

How about how PT’s can help the approx 50 million without insurance by being used in the much needed role of musculoskeletal evaluator and extender of care for primary care physicians? Why shouldn’t we use great examples like US military system, sports medicine, and many employers models where PT’s are the front line?  Aren't PT's capable of assisting in the innovative solutions like this Fast Company article points out about Walgreens?

What about supporting policy that addresses a principle driver of healthcare costs-notably conflict of interest that is well documented and highlighted in current discussions on healthcare regarding imaging but there is seldom a mention of PT and other over utlilizers like DME and surgical centers?  We could provide well documented examples and although it is far too late, provide funding for research in this area (note to Foundation for Physical Therapy-very disappointed in the lack of funding i after raising money for this clearly identified high priority effort only to have it put back on the backburner where it will undoubtedly be too little too late).

The mention of comparative effectiveness research is great but please bring it to life.  What about the utilization rates in spine surgery and the cost effectiveness of physical therapy interventions for LBP and knee osteoarthritis?  Perhaps a few testimonials?  Can we find a consultant who writes informercials?

Why even mention PQRI?  It’s adoption rate by PT’s is dismal and the program is a reimbursement cut for any of the disgruntled that are participating.

I sincerely hope there is a next rally-with materials and a strategy that is exciting and can create exponential numbers of PT’s carrying the banner of being part of the solution to healthcare by understanding the needs of the real stakeholders-the millions of those that are without insurance and the hi costs to those that provide insurance to their employees.

Thoughts?

larry@physicaltherapist.com

A New Poster Child(s)

Farah Fawcett was a complex individual who shared a very public account of the high and lows of her battle with cancer up until her death this week.  For many of us (that are old enough) we vividly recall 1976 Life magazine image of Farah which would eventually sell more than 12 million copies and become the best-selling poster of all time.  As I was sipping my coffee this morning I wondered "could there ever be another Texan that had the hair and smile" that could ignite a generation of style and fantasy.  Fortunately the Foundation for Physical Therapy Special Edition Calendar arrived in my mailbox today.  If the June Poster Child(s) is not the next Texas icon and trend setter I will be utterly floored.  Please give generously to the Foundation and make a difference!

Tim

Health Care Reform and Physical Therapists

When I hear "rally," I immediately envision "rally caps" and baseball and the hope and excitement of a cohesive team coming from behind to win the game.

So, okay, what I envision when I hear "rally" is very, very different than a "virtual rally."

This evening the American Physical Therapy Association hosted a "virtual rally" to help physical therapists make an impact on health care reform.

By October 31, 2009 President Obama wants a bill on his desk for him to sign.  He's waiting for a health care reform bill that takes into consideration his suggested 8 principles.

Do you wonder how the American Physical Therapy Association is representing physical therapists?  The APTA's perspective isn't a secret.  That page doesn't have too many details, but this paper on the Role of the Physical Therapist in Health Care Reform is a bit more detailed.

The APTA panel did an excellent job disseminating current information.  The rally could have been much better with less time disseminating information and more time entertaining questions and energizing participants.  Maybe my problem was I wasn't wearing my "rally cap?"   Maybe the real issue is that a "virtual rally" isn't the time or place for "rally caps?"

Every one of us needs to put on our rally caps because we have a role and we need to have our voices heard.  First, we need to stay current and pay attention to all the various proposed changes that will be discussed and debated in about 6 weeks.  The APTA created a Health Care Reform resources center updated with current information and podcasts.  It isn't enough to just read and stay current, the next step is to get involved.  Members can use the Legislative Action Center within the above link.  Nonmembers and consumers can use the Patient Action Center to become involved and have their voices heard.

Now is "rally cap" time... put them on... choose to let your voice be heard!

photo by sportsstan via Flickr

~Selena

Physical Therapists and Moving Forward

What's beer got to do with it?  A lot. 

Michigan Brewing Company does it right.  Greater success and growth happens the more you rely or network with others.  This company is an excellent example of how creating beer can be so much more than creating beer.  This company has embedded itself in the community and win-win relationships have occurred.  At the same time, this company also forged a relationship with an individual who was instrumental in changing Michigan law.  The change is better from a business perspective for this company and others like it.

As physical therapists "Move Forward," who have we networked with?  Who do we have win-win relationships with?  Are we moving forward alone in hopes for success?  Should we have fear in creating a foundation of moving forward WITH others with similar agendas?

What about nurse practitioners...  here is an opportunity for some mutual networking where together a better solution occurs:

During their “Raise the Voice” campaign, the American Academy of Nursing (AAN) stated that the role of community-based nurses should be reexamined during the healthcare reform debate, given the growing shortage of primary care physicians across the country. According to Tine Hansen-Turton, CEO of the National Nursing Centers Consortium (Philadelphia), “Now may be the time to "think outside the box" and increase reliance on non-physician groups and physician assistants and expand to non-traditional settings such as nurse-managed health centers and convenient care clinics.” HealthLeaders Media reports that 85,000 nurse practitioners – of about 145,000 – are currently providing primary care and that NPs are one of the fastest growing groups of primary care professionals nationwide. Donna Shalala, former HHS Secretary and a speaker for AAN's “Raise the Voice” campaign, noted that more recognition is needed for the role that NPs play in expanding access and providing primary care. She stated that nurses “need a seat at the table” during healthcare reform debates and additional federal funding for nurse-managed health centers. (Simmons, Janice. Group Says Community-Based Nursing Model Could Boost Primary Care Coverage, HealthLeaders Media, May 11, 2009)

We are an "outside the box" potential and we are a non-physician group.  Wouldn't they love to have us on board WITH them?  What are your thoughts?

Cheers!

~Selena

Random Thoughts About Healthcare

Since healthcare will undoubtedly be in the news for the next several weeks, I thought I would list some random thoughts.

-healthcare, medical care, and health insurance are 3 different concerns with some overlap between them.  When those that bad mouth our medical care site the decrease in life expectancy of US and other “health” measures, they clearly don’t know the difference.  Attempts to solve all 3 at once thru one sweeping legislative is a little naive in my opinion.

-while I can find a lot of valid arguments against a gov’t run single payors system, the oft cited “we don’t want beaurocrats making medical decisions” shouldn’t be one of them.  We already have that with every major private payor in the U.S. 

-I don’t understand the logical deduction that many are making when they state “comparative effectiveness means rationing of healthcare”.  If we don’t have some analysis, we might continue to have some chiro’s continuing to treat kids for bed wetting.

-The idea of mandating employer coverage for health insurance is completely unfounded. When are we going to realize that the employer model of health insurance hasn’t worked and won’t work as business challenges are daunting enough.  Employer model has been around for a long time and has essentially made big companies financially vulnerable and contributes significantly to increased cost of products/services and lack of companies being able to expand.  The vast majority of new jobs are created by small business-mandating insurance coverage might stop a new business in its tracks before it starts.

-There is plenty of money in the system to take on the 50 million without coverage but there isn’t enough providers.  Therefore, without force multipliers and deregulation around those that can provide services, there will be long lines and general angst.  The military healthcare system has been dealing with these issues for years and its system should strongly be considered as a model.

-given the hi percent of GDP on medical care, I do believe that a catastrophic health benefit should be a birthright and affordable primary care should be available.  The one thing you can say about medical care-even at its worst-there are true economic transactions and people performing services which is good for the economy as those employed do pay taxes (will avoid commentary about the failed bank crises and their number of employees by comparison).

-You can’t have healthcare reform without legal reform and business reform.  Significant cost drivers include “defensive” medicine and fee for service in “conflict of interest” business arrangements. The hidden cost of regulation contributes to to the problem.

-Consumers already exhibit a strong voice in their care.  Per FDA data, 70% of the time a patient requests a certain type of drug from their doc, they get it.  The idea that individuals can make complicated decisions about spending their dollars makes no sense at all.  Increased co-pays have not solved the problem and in many cases are counter-productive towards savings.

-There are generational differences in medical care. Older baby boomers generally trust their doc, younger generations are skeptical about their medical providers and they are comfortable doing searches on the internet to help them determine their best care.  They also want a CNET style of healthcare which will show them number of choices, lowest cost, and provider ratings. 

-Anybody who believes the gov’t knows how to implement “quality standards” ought to read about the adoption rate of PQRI by MD’s and PT’s.

-Not sure I understand why we aren’t looking at the success of mandating individual auto insurance as a model. This substantially opened the market to individual underwriting and competition which is something we don’t have in the health insurance marketplace.  Many employers would be happy allocating to an individual an amount of money for them to choose their own policy outside of their employer.

Thoughts?

larry@physicaltherapist.com

The 6th Vital Sign?

There just might be a race to define the 6th vital sign.  Field of specialty, for the moment, seems to be a variable that will create difficulty in defining the 6th vital sign.  What will be the 6th vital sign?

Unfortunately, the 6th vital sign I am going to mention doesn't appear in Wikipedia.  Last year at the Annual APTA meeting, Pamela Duncan, PT suggested walking speed be the 6th vital sign.  Recently a White Paper written by Stacy Fritz, PT and Michelle Lusardi, PT was published to raise the awareness and allow for discussion of self-selected walking speed to be the 6th vital sign.  The work that has been done on walking speed is quite interesting and vast: data suggests whether a person is dependent or independent, if the person has a likelihood of being hospitalized, if the person should be discharged to a skilled nursing facility or home, whether the person has a potential to fall or not to fall, and defining categories of how well the person is able to walk.

Body temperature... heart rate... blood pressure... respiratory rate... pain... and... ??  Are we ready for the 6th?  Do you think walking speed should be a measured vital sign?  Is the data strong enough to identify walking speed as the 6th vital sign?  Will this vital sign just be something to document OR can we alter this vital sign with our services and alter someone's life?

photo by Michael Brooking Photography via Flickr

~Selena

EIM Receives Small Business Award!!

EIM won the 2009 Greater Louisville Inc. (GLI) Inc.credible Award for an outstanding small business. This award plays tribute to the top small businesses in the Louisville, KY area and EIM received the award for businesses with 10-49 employees. Nominated businesses were judged on the following criteria: community involvement, growth in employment, number of years in business, financial performance, innovativeness of product/service, and response to adversity. EIM was selected specifically for its flexible workplace model that has allowed for inc.credible talent attraction and cultivation. In recognition of EIM’s accomplishments, GLI states in their announcement that “EIM has created a genuinely unique on-line/on-site, best practice marketplace (an ‘educational-studio’) for the advancement of musculoskeletal physical therapy practice, incorporating a variety of educational strategies in a coordinated fashion, including; weekend courses, on-line courses, topical discussion threads, on-line journal clubs, and residency and fellowship degree tracks.” GLI went on to state, ”What makes EIM special is their founders and professional faculty. While administrative services are centralized, their network of subject matter experts (faculty/instructors/authors) reside throughout the US and occasionally beyond national borders. These experts would not be able to closely collaborate if required to reside in single or limited geographic location. Keeping this virtual office in mind, EIM developed and launched the first (and at this time, only) distance-leaning based residency and fellowship education model for physical therapists.” Thanks to everyone that has contributed to EIM’s success! Visit GLI’s website for more information.

A Glimmer of Hope- An End to the Madness?

I have frequently commented on the madness of the spinal implant industry that continues to produce more and more surgery for neck and back pain with marginal to poor results. It is truly out of control.  I live in one of those high volume zones...  I always think that it can't get worse, however the 51 y/o female with neck pain that I saw yesterday might have topped the list.  Neck and "occassional" arm pain with an absolute excellent neurological exam was offered a 2 level artificial disk surgery for her pain!  The good news is that after 1 visit and dramatic reduction in pain and increased ROM that is not something she will be seeking. 

However, a glimmer of hope comes from hearing Atol Guwande's interview on NPR's Fresh Air  We have previously mentioned his New Yorker piece The Cost Conundrum on the blog and this expansion of this was superb.  The over imaging and over treating of many things including spine care was highlighted.  Kudos to Britt Smith, PT and his work in making Grand Junction, CO spine care better and cheaper.  I encouraged all EIM followers to tune into the NPR interview and forward the link to all members of your healthcare community.  

Tim

When Do We Raise the Bar on Our Expectations?

One day, will we rise to a challenge... a challenge that defines expectations?  What do we expect of ourselves professionally?  Can we learn to be candid?  Can we demand candidness in communications?

Chronic pain... we all know chronic pain is huge.  At this point in time, literature does not support a "magic bullet" answer.  When I read something like this, I ask myself why?  Has any work been done to substantiate the existence of primal reflex-related pain, the reliability of determining primal reflex-related pain, the validity of primal reflex-related pain?  Kudos for light clarification, "technique doesn’t work for everyone," but it leads to further questions for me - who doesn't it work for and at what frequency does the technique fail?  "... if the patient doesn’t show any response after the first session, the treatment is not likely to work," leads me to ask, how do you know?  Where is the data?  What about long term response?

I have nothing against John Iams.  Seeing the article just brought questions to me - questions I believe we all do need to ponder.  This list of "articles" may appear impressive to consumers and to those in pain.  We know better though.  We know that those "articles" have no relevancy to really help in choosing intervention options.

Is there a way to like the person, yet at the same time, raise the bar and expect something different and a bit more candid?  Primal Reflex Release Technique might be coming to your town.  How will you respond?  What can be the best plan of action to take that respects the person and respects creativity yet at the same time elevates expectations for candidness on the level of evidence?  Should we expect a change in the processes involved with creativity?  What should be expected before creative ideas are offered as credit for continuing education?  Should defined quality tiers be used to quickly and easily indicate the potential value the continuing education course may have?

~Selena

An Extreme Risk of Drugs

Not sure if a physical therapist was ever involved  in treating Danny Gans' chronic back pain.

Another potential risk when one relies on medications to "treat" chronic back pain.  Was Danny educated on all his options?  Were all the risks of those options shared with him?

~Selena