So many thoughts, so little time to blog. Thought I would send out some randomness:
-If anybody doesn’t think that we are our own worst enemy, look at this article that made national press release and that I sent to twitter world with the proviso that it is 20 years old
-lots of chatter on the listserves about Dubin Orthopedic Clinic who appears to me to be one of many unscrupulous docs that over the years has sent unsuspecting patients to his “physical therapy” space within his clinic. Of course, the “therapy” was administered by non PT’s. Thankfully, the good folks at the KY licensure board sought to protect the public due to the protection of the physical therapy term and numerous decisions, overturned decisions, etc. ensued. Of course we need to protect the term and ensure that the public is served in fact by PT’s if our term is used. However, I found it fascinating that in one of the decisions that it is clear that PT is not “defined” by the CPT codes that we use in physical therapy. I consider that a huge positive to fight the growing number of number within our profession that want CPT codes and medicare rules to become the ruling practice of physical therapy. Thank goodness the scope of what we do is governed at the highest order of our state practice act and the licensure board that assures its integrity. Left to our own devices, we will regulate ourselves out of existence.
-speaking of CPT codes, it has been pointed out to me by more than one very credible source that my criticism of the current codes needs to be viewed historically. They are correct, the CPT codes now are much better than the old days of hot packs for 30 min on comparable terms of therex. While improved, I strongly believe they are out of lockstep with current best evidence and the way in which PT currently exists in its finest form. Refinements are definitely needed but it is a lot easier to come up with solutions than it is to get them implemented in large part due to the whole notion of “budget neutrality” in code weighting and the obvious reality that CPT is typically preceded by “AMA CPT”. We don’t own codes that we are forced to use. I hope we can get some progress amending these in a beneficial way.
-is there any more stupid and redundant term than “skilled physical therapy”? Assuming that a medicare patient has met the criteria of medical necessity, what is meant by “skilled”? We can argue about effectiveness and outcome but the fact of the matter is that a patient under the care of a physical therapist is getting skilled care-100% of it.
-Much kudos to APTA on their response to Senate Finance committee Health Care Reform Policy Options. Their well thought out and written response includes items on POPTS, SGR, and efforts to reduce hospital admissions. You can access if you are an APTA member. If your not a member, dont’ be critical without joining first!
-I will be appearing at PT2009 in Baltimore at what I think is the 4th annual Rothstein Debate (my 3rd one-maybe they are just giving me multiple chances at improving). The topic is on Medicare Regulation and the growing attempt by PT’s within our profession that aren’t practicing day to day to make those the de facto rules of all PT including several of their superimposed nonsensical regulations that fall outside our practice acts. I know it is hard to believe that there are those within our profession that want medicare rules applied universally but it is a growing number. I only hope that whoever is debating me goes undercover and actually works seeing medicare patients in a clinic for at least 8 hours before attempting to defend the indefensible notion that we should sell out our practice acts for medicare rules. If you can’t attend, perhaps we can have a live twitter report at this lively discussion!
Thoughts?
larry@physicaltherapist.com
