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Anthem BCBS Profiteering and "Irresponsible Behavior"

Sparks flew, feelings were hurt and somebody got their noses rubbed in it in this riveting, nail-biting exchange between the House Commerce Committee on Oversight and Anthem/BCBS CEO Angela Braly and Executive VP Cynthia Miller.

Anthem BCBS is being called on the carpet for their 39% rate hike on the individual California health insurance market.

Some notable moments:

• Anthem BCBS posted a "reasonable profit" in 2009 of $2.385 billion
• Unadjusted Q4 2009 income of $2.7 billion - before the sale of a pharmacy benefits management company was excluded as a one-time gain.
• Ms. Braly's 2009 take-home? $1.1 million salary, $8.5 million in stock options and $730,000 in incentive bonuses.
• She made over $10,000,000 in a year where 25,000 ADDITIONAL Californians dropped their health insurance because they were unable to pay for it!

See the video:

Also see these highlights:

• Rep. Bart Stupak (D-Michigan) spanks the Anthem CEO for the practice of "recission" or as he calls it "purging sick people".
• Rep. Henry Waxman (D-California) pins Angela Braley's ears back for spending $3 million on meetings at 'a lavish resort in Scottsdale, Arizona'.
• Rep. Jan Schakowsky (D-Illinois), in perhaps the most passionate exchange, demands Angela Braly's salary data (see above).

Take home message to Anthem Blue Cross/Blue Shield:

When the US House of Representatives calls you to explain your profiteering and irresponsible behavior that harms Americans try to present yourself in a humble manner.

• Don't lecture the US Congress.
• Don't blame the healthcare consumer for being 'unsophisticated'.
• Don't blame doctors and hospitals for rising rate increases.
• Don't keep getting rich off of sick and dying Americans.

Tim Richardson, PT

PhysicalTherapyDiagnosis.com

CA PTs Picket Blue Cross & No Coverage for Captain America?

California PTs are going through a major decrease in payment from one of the United States biggest carriers - Anthem Blue Cross. 

Today, over 150 PTs and consumers picketed outside of BX's CA HQ in Woodland Hills.

Here is a brief video:

It appears that one of our country's greatest Super Heros is having coverage problems:

During these tough times for CA PTs a little levity sometimes helps.

Hang tough CA PTs. You are worth more than $63 and a copay.

David Straight, PT

Phone Consultations for Pain

Social media and how it is used will shape the experiences and beliefs of consumers.  The online world... what a world.  I saw a tweet from an individual who has 1,190 followers.  Phone Consultation Testimonial for Mike T Nelson: Low Back and Hip Pain

How would something like this work?  How about this as a potential example of what a one-sided conversation?

"Hello... Ya, I've had hip and back pain for 6 months."

"Aw, I'm generally healthy.  No, I haven't had any surgeries and I haven't been recently sick.  I'm just tired of having this pain."

"The pain is generally in my low back and my right hip.  It just kind of started happening.  I don't remember doing anything  to make it hurt."

"I figured for $90 and 100% guarantee I better give you a call."

What is it that entices people to choose a Z-Health certified person for a pain experience?

Wouldn't it seem reasonable to want to actually have a visual of the person in pain at the other end of the line?  What if the person was talking on the phone as in the photograph, would that matter?

Can pain be tackled via telehealth?  Is it reasonable to expect elimination of pain with the performance of various body movements (without any verbal or tactile cuing), eye movements, breathing exercises and nutritional recommendations?  What level of evidence is readily available to support telehealth for pain and for the Z-Health philosophy and recommendations provided?

Is it reasonable to have 100% elimination of pain?  Can pain elimination be guaranteed?

If physical therapists wanted to become more visible in the online world, would something like phone consultations be a reasonable option?  What about licensing?  Being licensed is a good thing, right?  Licensing, at bare minimum, defines knowledge requirements and hopefully is in place to protect the general public.  Is our profession restricted by state boards?  Meaning - if we do want to enter the online world with what we have to offer, are we only restricted to the states in which we are licensed?

I know I threw out tons of questions.  Does this strike a cord with anyone?  What are your thoughts?

photo by ernop via Flickr

~Selena

The knee is a dumb joint...

The knee is a dumb joint...

At least according to the evidence presented by Dr. Scott Greenberg, DPT, BSC, CPed, CSCS and his peers of the University of Florida Sports Performance Center.

 

Dr. Greenberg was one of the hosts of the world-class faculty at the Running Medicine Clinic at the Orthopedics and Sports Medicine Clinic in Gainesville, Florida on February 11th-12th, 2010.

Dr. Greenberg presented evidence that described the knee as an often painful, weak link between the ankle and the hip.

The course was presented by Course Director Kevin Vincent, MD, PhD and featured guest speaker Francis G. O'Connor, MD, MPH, COL, MC, USA.

Dr. O'Conner is the author of The Textbook of Running Medicine and the Medical Director of the Marine Corps Marathon.  Dr. O'Conner also happens to be active duty Marines and just finished a tour of duty in the Middle East, caring for US Navy SEALS.

The UF running conference is an annual occurrence timed to coincide with the Five Points of Life Gainesville Marathon

The course content was largely consistent with a surge of evidence arguing that knee pathology is often driven by hip and ankle dysfunction. Some of the most recent evidence was published, coincidently, in the February Journal of Orthopedic and Sports Physical Therapy.

Christopher Powers' PT, PhD Clinical Commentary article presents compelling data on hip biomechanics that summarizes the kinematic and kinetic data to date and may change common practice patterns for knee rehab.

View Dr. Powers slideshow on knee and hip kinematics (JOSPT log-in required).

Two ways to move the knee

Non-weightbearing: This image is an example of the dysfunctional lateral movement of the patella in non-weightbearing (like on a knee extension machine).  In this image the mobile patella is pulled laterally on a stable femur.

Weightbearing: Dr. Powers' article also describes lateral patella movement in weightbearing (like a single leg squat) where the mobile femur internally rotates under the stabilized patella.

Excessive hip internal rotation and adduction seem to be some of the most persuasive drivers behind common, high-volume conditions seen by physical therapists involving the knee.

Interestingly, Dr. Powers article presents some conflicting data: isometric assessment of hip muscle force producing capacity (strength) correlates poorly with the expected data on hip kinematics.  One possible source for this conflict is the high rate of measurement error with isometric muscle testing (eg: MMT).

If hip kinematics are the main drivers behind anterior knee pain then that explains the poor outcomes of arthroscopic knee surgery in two randomized , controlled trials from 2008 and 2002.

We've known for ten years (at least) the value of non-operative treatments to the hip, knee and ankle for primary knee pain.

Runners are just one of the many niche groups that benefit from the 'functional' physical therapy diagnosis.  

The knee is a dumb joint but a smart example of how physical therapist diagnosis can improve outcomes and decrease health care costs.

EIM Sports Physical Therapy Residency Program!!

EIM and Sports Medicine: The EIM Sports Physical Therapy Residency Program

EIM is excited to introduce its new Sports Physical Therapy Residency Program(SPTR)!  Dr. Teresa Schuemann has joined the EIM team as the SPTR content developer and director.  She is an experienced Program Director who has been Chair of the APTA Residency and Fellowship Credentialing Committee and now serves as one of seven members on the APTA American Board of Residency and Fellowship Education. 

“Going through a residency program was the best decision of my professional career”, states Dr. Teresa Schumann, SPTR director.  “I am thrilled to provide such and experience for other Physical Therapy clinicians.”

The SPTR is an 18-month program of post-professional clinical and didactic education for physical therapists designed to advance the physical therapist resident's preparation as a provider of client care services in sports physical therapy.  The SPTR incorporates key Orthopaedic Residency topics, such as Evidence-based Practice and Upper and Lower Extremity, with Sports specific courses, such as Emergency Response and SCS Prep.  The SPTR also requires Athletic Venue Hours in addition to Mentor Hours and Out Come Tracking. 

EIM’s SPTR is designed so that graduates will become highly skilled, autonomous practitioners who have substantially increased their ability to provide care to a full spectrum of clients with athletic injuries.  Sports Residents will gain a strong base of knowledge of evidence-based practice and preventative and rehabilitative sports therapy techniques.  Graduates will also be positioned to both achieve the Sports Certified Specialist (SCS) certification from the ABPTS and to be leaders in the sports physical therapy field.

The first cohort begins in June 2010 and the application deadline is May 1, 2010. 

Click here for additional details, SPTR FAQ’s, and the SPTR Fact Sheet.

Recognition and Awards

Last night I did something I have never done.  I always, always make sure I am in attendance at the geriatric section membership meeting because I learned years ago that during that meeting is the opportunity to really try to make a difference in the world of older adults.  In my heart, I believe this vast population of older adults is sometimes the group of individuals who have the highest potential of coming up with the short end of the stick.  I believe one way I can be an advocate for them is to make sure I share my thoughts to help maybe lead to change for this population.

Well, I made a very good decision and skipped the geriatric section awards ceremony to catch the very end of the orthopaedic section membership meeting.  I was hoping I wouldn't miss the orthopaedic section awards ceremony.  My heart lies with being an advocate for older adults but the bulk of what I do every day is truly within the world of orthopaedics.  I wanted to be present during the orthopaedic section awards ceremony to be able to not only congratulate but to also be genuinely happy for the recipients of awards.  One speech mentioned the ripple effect that instructors can have on students and it was true. 

No one is an immediate success.  Researchers don't have it easy because I am quite confident that behind every published paper you will find a trail of a few rejections.  For me, it is great to see researchers receive recognition for their work because I know they have a quality I call gumption... they don't stop when faced with rejection.  No one ever expects crash and burn to be a result of hard work.  When researchers reach success and their work is published, they unknowingly touch the lives of not only professionals in our field and our country, but their work can also have the potential to affect other segments of society.  A researcher's work is concrete, lasting and always available in its original form to be called upon in the time of need.  Researchers give a gift to society.

For those who received awards, thank you for touching the lives of others.

~Selena

The Conversations of Those You Meet

The scariest thing about attending a professional conference alone is, well, being alone.  When I head out to these conferences alone, I also have to pack a little box of courage and a tad bit of hope that maybe, just maybe I won't actually be alone.  For me the conference isn't just about the sessions and sitting and listening - I mean, I can do that at home by doing webinars or surfing the net.  The conference for me is an opportunity for exchanges of thoughts and feeling the pulse of what my colleagues are thinking and engaging in lively and memorable conversations which after the fact do become life altering.

I'm a girl that refuses to miss a lunch or dinner because without food I become a walking grouch.  Food... we all have to eat. So, yesterday morning I was completely starved because I was horrifically bad to my body the previous evening by 1) forgetting to eat dinner and 2) consuming alcohol as the only calorie source.  I had to do the highly unusual meal - breakfast.  The long lines made for the mental dilemma of what the heck was I going to do after I got food?  Well, I just pretended I was in France.  In France there is no written rule that the table you are eating at is only for you and your party.  So, I sat down with a group of physical therapist students from California.  Remember the days of your first conferences as you were either a student or new graduate?  Sitting with them brought back flashbacks - flashbacks of fear and feeling overwhelmed.  I think students have figured out how to reduce fear by coming to the conference as a group.  Too bad I didn't think of that concept back in the day... but I'm not sure if overwhelmed is the term I'd use for this group.  They were highly focused on what they needed for their classes and those types of topics.  What they didn't know was which sessions were being presented by great presenters, great researchers or the actual possible opportunity of a lifetime due to some presenters coming all the way from Australia.  I did my best to give a little bit of outside perspective and mild introductions about some of the speakers and the warning that sessions do close when seats are full.

Then lunch... as I was contemplating lunch and what I should do.. yet at the same time thoroughly disappointed that I had no lunch plan or anyone to engage with, I got awesomely lucky.  Right there, standing at the side of the hallway, all decked out in military dress was a gentleman I happened to be introduced to Wednesday night... Colonel Steven Hunte.  I was excited about actually seeing him because I had a burning question in my mind, "Why are you here?  I am so confused.  The card you gave me said you were a surgeon.  I want to hear about some of the cuts you've made and some surgical stories."  Yes, all of you in the military can just shake your heads and chuckle.  Colonel IS a physical therapist, even though PT isn't on his card.  His role is big picture - from creation of national policy to problem-solving international glitches within a perspective of health care and the health of those involved with the military.  The depth of his knowledge is mind boggling.  Colonel did have one very easy concept to grasp that is applicable to all of us... "do the right thing."  It seemed to me that he had a strong passion in making darn sure the right thing is done no matter the situation.  Thank you, Colonel.  I enjoyed my time with you and your message is one applicable to all generations and the future (no matter what the future holds).

Then, dinner... well, dinner plans fell through.  Crash, burn and fail.  So, procrastination set in for me which led to doing some laps in the pool.  After swimming there is one thing that has to happen in a reasonable amount of time - food.  So, I'm walking along determined I'm eating steak and I run into two therapists I met Wednesday evening.  Phil Tygiel and Al Amato kidnapped me as I was in pursuit of finding a steakhouse.  I was kindly accepted into an obviously pre-arranged dinner party.  It isn't easy to put into words how valuable and cool it is to learn and share different perspectives.   I will leave you with some quotes from those I met.  Quotes that should be food for your brain.

"In orthopedic physical therapy the significance of objective measurement is highly overrated."  Phil Tygiel, PT

"Physical therapists should be trained like lawyers...  when the evidence (law) is on your side, argue the evidence (law); when the evidence (law) is not on your side, argue the facts.  We need to teach physical therapists how to distinguish the facts in their case (patient) and apply the research appropriately."  Gwen Simons, PT, JD, OCS, FAAOMPT

"Physical therapists need to accept accountability for the results of their care."  Al Amato, PT

Has anyone else heard any thought provoking comments?  Any comments on the above quotes?  Enjoy the day... BTW - again, no food plans yet.  I'm excited to see what opportunities arise today!

~Selena

Combined Sections Meeting Kicked Off

Last night happened... I'm talking about The Very Unofficial CSM Meetup and Mixer.  For those of you who were unable to attend, all I know is I have been told that the "unofficial" is kind of like Vegas - what happens at the "unofficial stays at the unofficial."  A few light threats were made if I even thought of blogging about certain details.  Since I can't share what I heard, saw or felt, I'll just say I continue to be delightfully amazed by some of the people in this profession.

On another note... people with passion are magical.  Even though the event was fun, filled with laughter, teasing, a few debates and even the sharing of memories, I hope the professional passion last night was contagious.  For those who have professional dreams that seem independently unreachable, I hope some connections were made.  Dreams come true; the world is changeable.  A dream always hits a dipping point where you have to decide to bail on it or push through.  I am very sure others will always be there to help at the struggle point.  There are still 3 days here in the moment - take some time to focus on how your dream can become reality and who might be able to have some sort of a role in helping.

Thank you to PT Think Tank the host of the event last night.  A shout out does have to go out to one EIM guy in particular.  I won't mention any names, but his initials are JC  :)  Since I am not allowed to divulge any detailed information, I'm just going to leave it at thanks.

For those of you who are on Twitter, the attendees with high technology resources will be tweeting during the conference.  To see what's happening, you have some options.  You can follow @APTAcsm and you can search #CSM2010

~Selena

The Real Deal-NY Copays for PT Unintended Consequences

Great Story out of WSYR in Syracuse and a video to boot.  Part of a grassroots efforts by private practice PT's in the Syracuse area on the obscene cost of PT copays and the unintended consequences of them-including meds and surgery.  By grouping with specialists, patients pay a disproportionate percent of teh cost versus their percent for surgery!  We hope this message goes viral and congrats to Syracuse PT's.

Video also located here.

larry@physicaltherapist.com

Emergency? Call the PT

This profile in innovation on the AHRQ Health Care Innovation Exchange website is a nice reminder of a new and growing niche for PTs, primarily staffing (or on call) ERs as a consultant for patients with musculoskeletal conditions. There are a couple of recent publications (here and here) that have described the potential role of PTs in emergency rooms, but it's still a very new (and I suspect uncommon) opportunity in practice for PTs. Since ~15% of all individuals presenting to an ER have complaints of musculoskeletal conditions amenable to PT, there is lots of opportunity to decrease unnecessary imaging, drugs, and referrals to specialists for invasive procedures. Carondolet St. Joseph's Hospital in Tucson, AZ has certainly been an innovator in this areas. Curious to hear if others have started similar programs in their communities.

John