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Sen. Cornyn to Highlight Benefits of Prevention & Workplace Wellness at San Antonio's Frito-Lay Facility

AUSTIN—U.S. Sen. John Cornyn, R-Texas, will be in San Antonio Thursday, January 14, to visit the Frito-Lay Food Manufacturing Facility and see how local company Fit For Work LLC is helping Frito-Lay employees prevent work-related injuries and lower health care costs. Studies show an emphasis on workplace wellness leads to a healthier and more productive workforce, along with savings on health costs. Sen. Cornyn will be briefed and have the opportunity to see a training demonstration in which Fit For Work staff will train Frito-Lay employees how to carry out their responsibilities at work in a way that promotes wellness and prevents injury.

Sen. Cornyn believes a focus on prevention and wellness must be central to broader health care reform efforts in Washington. He has introduced two bills that promote the concept of workplace wellness and disease prevention: the WHIP Act and the Healthy Workforce Act. The Workforce Health Improvement Program Act, or the WHIP Act, is a bipartisan measure that would level the playing field for small businesses that cannot afford to provide an on-site fitness facility for their employees. Specifically, it would allow employees to exclude from their federal taxes up to $900 of any off-site wellness benefit they receive from their employer.

In the same vein, the Healthy Workforce Act would provide a tax credit to companies that offer effective and comprehensive wellness programs for their employees.

• WHAT: Sen. Cornyn To Highlight Benefits Of Prevention & Workplace Wellness At San Antonio’s Frito-Lay Facility  
• WHEN: Thursday, January 14: 2:50 p.m. – briefing and demonstration & 3:30 p.m. – media availability
• WHERE: Frito-Lay Food Manufacturing Facility, 4855 Greatland Dr., San Antonio, TX  78218

Background on Fit For Work:

Fit For Work is a San Antonio-based company that is hired by labor-intensive businesses to provide their employees with injury prevention techniques. Fit For Work’s techniques include training, ergonomics, and identifying musculoskeletal disorders through on-site clinical diagnostics. Since Fit For Work implemented its program at the San Antonio Frito-Lay facility in 1998, Frito-Lay has seen an 86% reduction in injury frequency and has not experienced an ergo-related injury in the last 7 years. Frito-Lay estimates it has saved millions of dollars as a result of these preventive measures.

Yes, Gina you can tell if your physical therapist is "voodoo less"

And Dr. Irrgang’s litmus test is just a start.

In what might be the most emailed article to hit the social networks of physical therapy comes this gem from the NY Times entitled Treat Me, but No Tricks Please by Gina Kolata.  I wish more consumers were as inquisitive as Ms. Kolata as it would be a boon to PT practices that train, practice, and insist on evidence based practice.  I only hope that Ms. Kolata likewise inquires her physicians on treatment interventions for other conditions-am confident that it would highlight even more the significant lack of evidence in medicine generally.

The article raises great points-evidence, cost of PT, unproven interventions, stretching, research and apparently the easy referrals generated by MD’s in New York for physical therapy (side question for Gina, do these docs refer to their own clinic or any clinic?).

For purposes of narrowing the focus to make a point, I am only going to concern myself with the last issue raised:

“with all that voodoo physical therapy out there, though, how can you tell if what you are getting is helping or useless?”

Dr. Irrgang essentially suggests that you have to be inquisitive and find a PT that can explain the benefits and risks of various treatment options and who can defend evidence to support their treatment.  I think this is a good start. 

I would add the following 4 questions:

*Can you provide evidence to support treatment in the most common PT diagnoses-low back, cervical, upper extremity, lower extremity, and therapeutic exercise generally.

*Are you board certified in your specialty area, residency or manual therapy fellowship trained?

* Can you supply reports from external organizations that indicate your patient satisfaction/loyalty or clinical outcomes?

* How does your organization provide PT’s on-going training and feedback to ensure consistency and decreased variation of treatment interventions across the most common conditions? 

My recommendation to Gina or any other inquisitive consumer is if the answer to any of the questions other than the second one is “no”, move on until you find a “voodoo less” therapist.

I look forward to the thoughts and comments on this issue and the NY Times article.

larry@physicaltherapist.com

 

Clueless in California-Blue Cross Way of Improving Health

There is nothing worse than a health insurer taking a slam at an entire industry.  There is nothing better than seeing grass roots efforts to point it out.

The former was done by Blue Cross of California to its physical, occupational, and speech therapy providers via a letter and informing them that their reimbursement is being cut as of Feb 1, 2010 to a maximum of $75.  Additionally, in only ways that immoral health insurers understand, a non negotiable standard form contract has to be executed or the clinics will no longer be able to see Blue Cross patients.  keep in mind that Blue Cross controls the market as California’s largest private insurer-by far.  This action is akin to Marcus Welby coming home to tell his family that his income has just been cut by 40%.

Citizen marketing and raising awareness about this issue is the unforeseen action that Blue Cross (whose stated mission is to “improve the health of people we serve”) probably didn’t anticipate.  Check out this blog post on The Huffington Post-perhaps the world’s most read blog.  I hope that California physical therapists take the same action that they did in NY when something similar happened-march together and force a meeting with their CEO.  Here are a few things that he should know:

-Your customers are employers.  When you decimate an entire industry, you might want to inform them before you inform the providers.  If you had done that, you might have refrained from slamming PT’s with such Draconian cuts.  Your customers have had positive experiences with PT’s. 

-PT’s have been shown to be an integral solution to musculoskeletal problems-particularly hi cost drivers like low back pain.  In Seattle, treatment time for LBP has been reduced from 66 days to 12 using PT’s as part of solution. 

-Enlightened insurance companies have INCREASED fees to physical therapists because they have focused on cutting costs in the real downstream costs of expensive tests and specialists.  That’s right, “you have drugs, surgery, imaging, or us”.  A simple analysis of the data will show that after six months of implementing this massive fee reduction that these downstream costs will increase-ultimately forcing increased costs to your customers-employers.

-while PT’s might be coded with “peace corps genes”, we are highly educated patient advocates and won’t sit still while your shortsighted actions take place-and neither will your customers.  In the days of social media and word of mouth marketing, Blue Cross of California might just get the Tiger Woods treatment in the press.

Then tell him Happy Holidays and expect to hear more from us in 2010.

larry@physicaltherapist.com

Winners of the EIM 2nd Annual Elevator Pitch Competition!

The winners of EIM’s 2^nd Annual Elevator Pitch Competition are….

·         1^st: Chris Robl- http://www.youtube.com/watch?v=KiEDB8V3zkk

·         2^nd : Cori Cameron- http://www.youtube.com/watch?v=-lZCLA_YQkA

·         3^rd : BJ Lehecka- http://www.youtube.com/watch?v=cMgRzAaZzW8

 

Thank you to all who submitted entries in the competition!

Physical Therapy and Spinal Cord Injury

The choices people make and why they make them captivates me.  For a couple of days, I've been thinking about how to convey, in a kind way, something I read.  The mom's choices and actions didn't bother me - she's really doing what any good mom would do.  What bothered me, "I would call physical therapy places... they either didn't have the equipment, or the manpower or they didn't take my insurance." So, the daughter is now 2 years or so post spinal cord injury and this is what she states about the recovery center her family owns, "There's no other type of therapy place that offers hope like we do. I get to work with them and we get to reach our goals together," says Amanda.

My curiosity always takes me through some cognitive journey.  I wondered what was available in Florida for people with a spinal cord injury.  The first thing that came into my head was the Miami Project.  They have made a huge dent in understanding spinal cord injury.  I didn't easily see information on becoming a patient, but with a bit more searching, I found the University of Miami does have a Department of Rehabilitation.  Amanda's mom didn't indicate anything that occurred in the initial stages of rehabilitation or where rehabilitation occurred.  Somehow she found Project Walk.  Project Walk hinges its whole entity on the Dardzinski Method and the Five Phases of Recovery.  Interestingly, as I tried to learn more about the supporting evidence of the theory, I was led to a neat paper written by Professor Mary Galea who shared on page 8 of that document her thoughts on Project Walk. Galea also included a reference on intense exercise and spinal cord injury by ET Harness. 

Stories sell.  All the stories seem to revolve around hope.  The clients are more than willing to pay $100 or more an hour out of pocket for sessions 3 times a week.  I didn't see a single claim of actually walking independently again.  I wonder how the physical therapy sessions ended?  I mean, the mom could have continued paying for services out of pocket... the physical therapist could have continued to work with the daughter providing intense exercise.

If a patient believes the relationship with us is coming to an end too abruptly and would like more services, how do we handle the whole end of insurance benefits for the condition?  Are we a factor that propels people to pay for unproven methods and potential false hope?  Is it wrong to continue a working relationship if deep down we believe no substantial progress will occur?  Is it wrong to attempt to help a patient to learn to accept and cope?  Why do some patients view this as giving up?

~Selena

EIM 2nd Annual Elevator Pitch Contest Deadline!!

Don’t forget that EIM’s 30 Second Elevator Pitches on why physical therapy is the Best First ChoiceTM in musculoskeletal care are due on November 30th.

Top prize is $1000, second is $500, and third is $250!
Check out Elevator Pitch info on Wikipedia or see last year’s winners… first, second, and third places.

Video and Audio submissions are taken via email @ elevatorpitch@evidenceinmotion.com

Rules:
• MUST answer “Why Physical Therapy is the Best First ChoiceTM for musculoskeletal care?”
• 25-30 Seconds (no longer, no shorter)
• Individuals Only
• Must be a PT Student or practicing PT
• No Entry Fee
• Submit via email @ ElevatorPitch@EvidenceInMotion.com
• Include name, email address, school or place of work, phone number, and age with submission
• Must be in the form of video or audio files
• Submissions are due no later than 11:59pm, November 30, 2009
• Winners will be announced on Facebook, My PT Space, and YouTube on December 15, 2009 at 4pm
• First place will receive $1000, second gets $500, & third gets $250 (winners contacted via phone & email)
• All submissions and their content will become the property of Evidence In Motion, LLC
• Email ElevatorPitch@EvidenceInMotion.com with questions and visit EIM’s website for more info

The Results of One Court Case Will Affect the Nation

Is an orthopaedic surgeon a "qualified health care provider" with regard to providing physical therapy services?

According to the Kentucky Supreme Court, yes, an orthopaedic surgeon can provide physical therapy services and is a qualified health care provider. What can I say? Over the last 6 years, the case went through the whole darn court system and a final ruling occurred in the Kentucky Supreme Court. The result... since section (1) proviso allows orthopaedic surgeons the authorization to provide physical therapy services, but since section (3) disallows the orthopaedic surgeon from referring to the services as physical therapy either directly or indirectly - an "absurd" situation is created. Apparently, the General Assembly wanted the statute to be considered as a whole and for all pieces within the statute to be relevant. The General Assembly would not want an absurd statute.  It all comes down to it being absurd that an orthopaedic surgeon can't offer and bill for physical therapy services provided by an athletic trainer using CPT 97001 and 97002.

Personally, I find it not only absurd but also illogical that an orthopaedic surgeon would be allowed to provide physical therapy services without a physical therapist providing services.

If we put some practicality into the situation... first of all, an orthopaedic surgeon is not in the clinic every day of the week.  The "surgeon" will have 1 or 2 days (or more) per week in an operating room, right?  So, when the surgeon is operating, the surgeon really can't be supervising any physical therapy services that might be concurrently provided within the surgeon's clinic right?  We'll forget about that reality for a minute.  When the surgeon IS in the clinic, what is the surgeon doing?  If we guesstimate the surgeon has an 8 hour working day, then that means the surgeon has basically 480 minutes.  Of that 480 minutes, the surgeon will probably have 20% downtime - waiting for radiographs or MRI results or conversing with other colleagues or documenting... that leaves 364 patient contact minutes.  Approximating an average of 10 minutes of surgeon-to-patient contact, a full day would be approximately 36.4 patients.  In that full day of surgeon-to-patient contact, does it seem reasonable that a surgeon would have the time to adequately address and supervise the provision of physical therapy services being provided by an athletic trainer?

Until third party payers eliminate referral for profit situations, the Kentucky Supreme Court opinion just may create ripples across the nation substantiating the legal right for physicians to provide physical therapy services.  Until consumers care enough to compare before they seek a physical therapist for their condition, the situation won't change.

Is it possible for physical therapists to create a viral message?  Physical therapy isn't physical therapy without a physical therapist. Put the PT in physical therapy. 

What are your thoughts?

~Selena

2010 International Private Practice Business Summit!!

Larry Benz at the 2010 International Private Practice Business Summit

 

Hello!

I would like to personally invite you to the 2010 International Private Practice Business Summit on January 22-24, 2010.  The Summit is a 3-day business meeting for private physical therapy practice owners. There will be more than a dozen experts presenting on topics related to the business of physical therapy and strategies for creating high performing and prosperous world-class clinics.  This Summit will motivate, inspire and teach everything you need to know to transform your clinic into a top-notch, competitive, enjoyable business. 

 

I will be presenting “Clinical Excellence Begins with World Class Customer Service”  on January 22^nd.  While physical therapy clinics are stressing their clinical expertise, practices with unprecedented focus on the customer experience and service excellence are gaining market share, “buzz”, and loyal repeat patients trumpeting their competition.  I will focus on the ultimate outcome of a physical therapy experience-an emotionally engaged, enthusiastic ambassador who has been impacted for life from treatment at your physical therapy clinic.   This session will give you the tools to deliver and sustain “the best” customer service experience for your patients.

 

Registration opens today, October 28.  If you register prior to November 19 you will receive an early decision maker discount.  Click here to register.  

 

Hope to see you there!

Larry

Medical Necessity... To Fix A Problem There Cannot Be Two Standards

Health Care Reform... 21.5% reduction in payments to providers... possible shifting of reimbursement to favor primary care physicians... possible reducing payments to physical therapists to increase payments to cardiologists and oncologists. 

It seems to me to really resolve any problem there are always various considerations.  In the case of health care reform... there are at least 3 entities to consider.  1)  Medicare - its processes:  the inefficiencies, strengths and weaknesses  2)  Providers -  their processes:  how clinical decisions are made, the risk/benefit of the decisions and 3) Patients - their behaviors:  when they seek services, their responsibility in taking care of themselves, when they make poor choices.

I am so ready for a primal scream when I see something like the above and then read the details.  The government can't have it both ways... their audits in clinics capturing money paid inappropriately due to lack of "medical necessity" basically based on review of records yet the allowance of $60 billion in fraud to people who easily scam Medicare!  Medicare is paying for that fraud annually (of course, these are just the ones who got caught)!  In all honesty, providers should not take such a hit in reimbursement yet.  Medicare should have its own work cut out to clean house and ensure someone really needs an electric wheelchair or an electric prosthesis.  Amazing to hear Medicare will easily pay for 2 lower extremity prostheses and an electric upper extremity prosthesis on the SAME person!  Now come on, how many people 65 and older do you know who are THAT bionic?? 

I have no clue how powered mobility devices are billed.  I do know if a patient received any kind of prosthesis concurrently there would be claims sent for physical therapy and maybe occupational therapy.  I would think a darn computer system could process durable medical equipment claims for defined durable medical equipment items 20-30 days after receiving the claim and only pay if inpatient services or outpatient physical therapy services were provided within the same time frame.  I'd highly doubt anyone receiving a prosthesis would know how to function and be safe without some level of education and training.  Even if the prosthesis was a replacement, Medicare can just make a rule that rehabilitation services are required. 

If 10-12% of claims are for physical therapy services, does it seem strange to anyone else that OIG will be focusing on outpatient physical therapy services provided by independent physical therapists?  I highly doubt that physical therapists in independent practice are exploiting the Medicare system intentionally or unintentionally at the magnitude the guy in the video was.

~Selena

Meet Molly, the Pony with a Prosthesis

     

Every day physical therapists work with people who have some level of disability.  These people always have some degree of work cut out for them to reach their maximal potential. 

Wouldn't it be great to have the power of a "Molly" readily available?  I'm not talking horse power.  I'm talking about the power of the connection people have with animals - animals they don't even know.  It always amazes me how easily people perceive animals as smart, determined, friendly, understanding, or special.  Molly has been traveling and inspiring soldiers with amputations, kids with cancer, and normal healthy kids.  Do you need to somehow connect with kids and have no Molly? You can order the story: Molly the Pony - a True Story.

How do you motivate your patients who don't seem enthused about putting forth the effort to reap the benefits of physical therapy?

photo by muskokarocks via photobucket

~Selena