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Shifting Positions is No Position-Get Rid of Caps Permanently (and some other things)

On Dec 19^th , our national association wrote a letter to U.S Senator Max Baucus on the Call To Action Health Care Reform 2009 which proposes a framework to address access and achieve affordable health care coverage for Americans.  On Dec 18^th,a short letter was written to President-elect Obama.  For those of you who are members, you can access the letters here.  For those of you who aren’t member, you should join. 

While we respect our national association and agree with a few of the items in the letter, much of it is far off the mark – see details below.

Overall, the problem is that the APTA seems to be advocating for the wrong audience.

Healthcare reform is supposed to be about addressing societal needs, whereas, these letters primarily are focused on ‘we the physical therapists”:

 

-          Defining our qualifications

-          Giving stature to PTAs

-          Getting payers to “recognize”  us

-          Suggesting that we can improve access to care and reduce costs by mandating that “….physical therapist services will be provide only by physical therapists and by PTAs under the direction of PTs.” 

A statement we find at best mystifying.

-          And all those references to our “vision”….please,  who in with world CARES about our vision of us?  Or cares that “physical therapists will be practitioners of choice in health networks, and will hold all privileges of autonomous physical therapy practice…..etc….etc….

 

 

The Baucus letter touches on many key points which we support.

On the other hand, under the header “Improving Value by Reforming the Health Care Delivery System”

1. One gets the strong impression that our national association represents the primary care physician association. While the real issue here is that reimbursement undervalues primary care which has resulted in a massive exodus of physicians from primary care to better paying specialties. While we support revising the reimbursement methodology to better recognize the value of primary care services (INCLUDING physical medicine and rehabilitation) PTs offer an immediate solution to the primary care manpower shortage.

 And to that end we should be trumpeting PT’s as direct access providers, treating musculoskeletal conditions as key  members of the medical team

2. Few PT’s work in day to day wellness and prevention and the recommendation is to enhance coverage of these services although politically correct is not defensible in a system that is broke.  How about paying us for the things we do on a daily basis?

3. I have yet to meet a PT who has “embraced the PQRI” as represented.  All find it a pain in the arse and many aren’t doing it simply because the cost of complying is greater than the cost of reimbursement and many that have painstakingly done it have yet to receive their check!

4. Seeking to make the exceptions process permanent? 

Update, Update  Fortunately, John Ensign (R-NV) and other Senators have thankfully submitted 546/HR43 which would eliminate the Cap.  This is THE position to take by all PT's.  Extending the exceptions process is not a good option-it only makes day to day practice burdensome and does not work-this analysis explains why.

5. Seeking to provide incentives for the wide-adoption of health information technology?  Moving medicine into the electronics age certainly makes sense.  But the claim that our national association has developed an electronic health care record and national outcomes database would make one believe that there is widespread adoption of OPTIMAL and CONNECT-this couldn’t be further from the truth.

6.  Pay for Performance (P4P) is a great idea.  But we’ve not seen the concept translated to practice.  And that’s why we see scant support of P4P .  Kind of hard to believe when you have a guideline put out that is so restrictive that it virtually eliminates the whole notion of P4P including the notion that the program has to be “voluntary” and can’t disadvantage a provider-the whole proviso behind P4P  (side note:  I am against P4P because it has yet to be demonstrated to be effective and almost all tests for this are really P4C-pay for compliance). 

The letter to President-Elect Obama is clumsier than a wobble board.  If you can get past the 5x mentions of PT’s and PTA’s so closely linked that you have no idea that there really is a difference, you are left with the impression that PT’s (and PTA’s under direction and supervision of PT’s!) are in the wellness and prevention field.  I am sure this letter will be file in the “failed to impress section” of the shredder.  (side question:  do you think AMA would mention PA’s 5x or ANA mentioning nurse’s aids 5x in a letter to the new administration)?

Can letters from our advocacy please stand up to some review process before hitting the send button?

Rick@physicaltherapist.com

larry@physicaltherapist.com

 

Happy Holidays from your friends at EIM

We appreciate all of your support.  Enjoy!

Yes Virginia, Even You Can Have Your Own Personal Ultrasound Unit

I am known for my horrible taste in Holiday gifts.  I would much rather fly the whole family to Montana for a week of skiing than exchange gifts under the tree. Also, I like gift cards and I give gift cards. Perhaps it was the "Chia Pet" and "The Clapper" I got some family members on that Christmas a decade or more ago that sealed the acceptance of the token gift card. 

This past week when a patient brought an ad for a home ultrasound device into the office, I began to rethink the gift card thing.  Why don't I just get everyone their own home ultrasound device for the Holidays.  According to the information on www.ultrasoundcure.com their portable ultrasound units are:

"radically changing lives and the professional therapeutic community. A low cost, safe, easy to use unit allows professionals to provide their patients with units to take home and use for the duration of the healing process. This means you can get your treatments 3 times per day, every day, instead of just a couple times per week. That's 10 times as often - 10 times the benefit - meaning a much less painful and more speedy recovery"

Sounds (that's a pun) like a nice gift for the loved one - doesn't it?  Just wait, if you order now you get more because:

"The units come with our naturally medicated ultrasound gel that, through the process of phonophoresis, delivers anti-inflammatory and pain relieving ingredients deep into the body. Together, the combination of phonophoretically delivered medications and regular ultrasound therapy provide incredible pain relief and speed the healing process."

Please check out the links above.  The website is full of a lot of additional information about how ultrasound and its healing properties can help athletes and those experiencing chronic pain. The units are priced at $99. This price is only guarenteed for the next week.  But wait, like the above quoted statements, the website also claims that:

"If you don't have your own Portable Ultrasound Machine, don't worry. All on its own, MendMeShop Gel is an effective therapeutic product when massaged directly into the skin. If you're curious about the difference between applications with and without ultrasound you can always visit your local physical therapist or chiropractor with your own bottle of gel. They should be familiar with our product and its application."

So help me out, I really wanted to get Larry, John, and Rob at EIM something for the upcoming Festivus season.  Should I go with the home unit and Bulgarian lavender infusion gel - or perhaps stick to the basic Starbuck's gift cards?  As always, I look forward to your comments. 

5 Things I learned during a blogging sabbatical

I’m back after a self-imposed blogging vacation for the last several weeks.  Under the famous banter of “the more things change, the more they stay the same” are a few things observed:

1.  Although they credit the “grass roots” effort, it appears to me that our national organization single handedly took the credit for getting the 10% cut in medicare repealed and for overriding the veto-they might have set the bar a little high.  Note to file: anytime the AMA fights something big with huge national campaigns and dollars, stay in the sidelines, save the time and expense and use the money saved to fight CMS’s attempt to over regulate us out of existence.

2. PT hospital administrators are the most sensitive in our profession.  I made a simple comment on a listserve frequented by them that many PT’s work in hospitals in part because they don’t want to “mess with financials”.  You would have thought that I spread the west nile virus.  A VA PT made the comment to the effect that there are times when the distinction between PT and OT are blurred.  You would have thought he suggested eliminating diversity articles from the PT magazine.

3. Our PR efforts nationally have now gone from Blackberry thumb to Tummy Time.  Great progress on that front-we’re on pace for  “slimming” hip huggers in about 6 months.

4.  At least 2 commenters on this blog are being sued for 1 Million Dollars for comments they made about John Barnes.  Isn’t that ironic on a blog whose focus is about evidence based practice?  Does that give this blog more or less credibility?  Poor Barry Dorko got blasted by the attorney in the comments.  Perhaps he should change his name to Barrack?

5. According to my filtering sources, physical therapy is mentioned an average of 56 times per day in web articles and blogs and shows up in Twitter via my Tweetscan about 14 times per day and growing.  Another words, we get about 1% of the hits that a personal trainer or a massage therapist get.  Perhaps personal trainers should start promoting Tummy Time?

Thoughts?

larry@physicaltherapist.com

Live Convention Bloggers?

A super trend in blogging is conference “live blogging” whereby one or many bloggers post real time at a conference.  It is especially helpful to those who cannot attend.

Anybody want to give it a try at APTA’s National Meeting in San Antonio this week?

If you want to volunteer or are “live blogging” for your own blog, please let us know at MyPhysicalTherapySpace and we will certainly link to you or give you the ability to co-post on this site.

A couple of lectures or presentations where this would be fantastic:

Opening Ceremonies: Wednesday, June 11th from 5:30 pm—7:00 pm, featuring Lee Woodruff

 

McMillan Lecture: Thursday, June 12th from 11:00 am—12:00 pm, presented by Anthony

Delitto, PT, PhD, FAPTA

 

Maley Lecture: Friday, June 13th from 11:00 am—12:00 pm, presented by Pamela G Unger,

PT, CWS, FCCWS

 

New! Oxford Debate: Friday, June 13th from 5:15 pm—6:15 pm

 

Current Controversies in Physical Therapy: The 2008 Rothstein Debate: "Does the Current Model of Clinical Education Really Prepare Students for Practice?"  where I will be participating against some brave taker who represents a side of this opinion that clearly has few supporters

 

And lastly we have the Physical Therapists and 21st Century Health Care: Direct Employer Contracting is the Way Forward where we have several members of our EIM team, Fit For Work, and Tony Delitto presenting.  If you want to see several hundred slides fly in a matter of minutes using the Lessig style of presenting, please be there!

 

larry@physicaltherapist.com

Who Do We Tell? Our Iceberg is Melting!

John Kotter tells a great story.  I know our iceberg is melting.  Can a collective we (meaning all providers) find a solution?  What about us as a profession, we're such a small piece of the pie, what is our plan for survival?  What would the United States be like without physical therapists?

Without physical therapists, employees would have more days off work due to back pain which would increase cost to employers.

Without physical therapists, consumers would have increased costs with less than optimal options including more medications, more surgeries, more days off work and a wide variety of unlicensed and licensed individuals who would provide very focused services with a "feel good" nature that would miss the mark in providing long term benefit.

What would happen to people who have had surgical procedures?

What would happen to people who have had a cerebrovascular accident? 

And the geriatric citizens in our society... would falls become even more prominent?  Would these citizens have any qualified professional to improve their function to increase the likelihood of maintaining their independence?  Would less and less of these citizens be able to live in their homes?  Would skilled nursing facilities only have nurses providing unguided maintenance?

Our world is all about "me."  Should we take a step back and listen instead of tell?  I wonder if, for our environment to really change, if we should definitively know what we as a profession of diverse individuals truly want.  What's the bottom line?  From what I have read and discussed with other therapists, we want to be THE neuromusculoskeletal experts and reasonably paid for that expertise.  What we want really doesn't matter in a "me" world though, does it?  You see, the more we talk about "me," the greater the likelihood we've lost our ability to persuade anyone we are the experts. 

Who is it that we need to "sell" ourselves?  How about consumers, third party payors, employers and legislators?  Each entity has a different need.  We provide a service that meets the need each of those entity's desires.  Of course, each entity will require a different tactic.  Our financial resources are an obstacle.  Another factor is greed (check out pages 6-8).  How much profit is too much profit for a non-profit organization that can increase its profits by paying providers less?  How can we create change with these barriers?  How can we show that we really can meet the needs of the various parties?  Do we really have a rapport with anyone that can create a path that leads to our bottom line?   

Strides have been taken to create change.  Why is it that as a whole we are consistently unsuccessful in reaching our bottom line?  Could it be something as simple as not being good in a room?

Selena

iceberg by frenchy_rjp via Flckr

BullDog Award

This may be the ultimate trivia question never to appear in Trivial Pursuit…the winner is….. Maloney & Fox, a Fifth Ave marketing agency for their brilliant and perhaps society breaking expose on “How to Prevent Blackberry Thumb”.  This may very well be the butt of jokes for several years and a symbol for the failure of PT marketing by the old regime at APTA.

All of this news and more has come thru the very healthy debate caused regarding the recent post regarding The Petition (signed by over 700 at this time).

I believe what has been lost thru the various traffic on EIM blog , MyPhysicalTherapy Space, and the HPA listserv is huge desire (passion) on the parts of PT’s to substantially enhance and improve the PR and marketing “branding” of what PT’s do on a day to day basis.  All APTA members know that the “petition” has no process authority but it does go to show that in less than a week 700 plus PT’s and numerous others who have not signed but have commented really care on the direction of where we are going and believe that our national association has a role in promoting PT as a “brand” along with PR.   This should supply ample ammunition for the new leader, John Barnes, who everybody is excited about, to put new systems and resources in place.   What also has been lost is the value of the internet in transparency and communication in uniting many PT’s to come together thru email (HPA listserv), blog (this site), and social networking (MyPhysicalTherapySpace). 

An email regarding the efforts in the 2007 House of Delegates was listed in an email which was meant to highlight subjects during the first 6 months of 2007.  Listed also is a simple suggestion to the marketing department for the disposition of each:

The New York Times on 'Physical Activity during Pregnancy Bed Rest" - RETURN THE PHONE CALL

 

The Associated Press on 'Back to School on Sports Injuries and Kids'- RETURN THE PHONE CALL IF YOU HAVE TIME

 

Newsweek on 'Healthy Holidays' - IGNORE, ENJOY MORE OF YOUR HOLIDAYS YOURSELF

 

USA Weekend on video game injuries - IGNORE, PLAY SOME WII YOURSELF, YOU MIGHT ENJOY IT

 

Gannett News Service: Bike Fit - IGNORE, GET YOUR OWN EXERCISE

 

AARP Magazine: BlackBerry Thumb - DEFINITELY IGNORE UNLESS YOU CAN RAISE A SINGLE CASE OF A PATIENT EVER PRESENTING TO PT WITH THIS CONDITION

 

Los Angeles Times on 'Rotator Cuff Injuries' - RETURN THE PHONE CALL IMMEDIATELY

 

Kiplinger's Personal Finance on "Arthritis Care" - RETURN THE PHONE PHONE CALL IMMEDIATELY

 

Shape Magazine on 'Blackberry thumb, Office Injuries" - SAME AS BEFORE

 

Quick and Simple on "how to lift anything", "how to stay healthy while traveling", "how to safely flip a mattress" - C'MON, THIS REALLY NEEDS A PT?

 

Consumer Report on "Preventing Shoulder Injuries" - RETURN THE PHONE CALL

 

Prevention on "Avoiding sprains while Exercising" - - RETURN THE PHONE CALL IMMEDIATELY

 

Having said all of this, I have one much larger question. Why is APTA not getting bombarded with calls about back pain? Isn't this 40% of what is seen in outpatient orthopaedic PT, which represents the largest sub-group of PTs? How about stroke? I could go on. The bottom line is that focusing on "minority" interests has gotten us into "major" problems when it comes to defining the PT brand.

 

We're looking forward to a new leaf with new leadership in 2008 that understands that a marketing campaign should be focused around your greatest strengths. Forget trying to be everything to everyone when it comes to marketing and branding. Minority interests will ride some powerful coattails if we can get over trying to please everyone.  Trying to please everyone (APTA strategy under old regime)=no one happy, which has only worsened our already severely diluted and worthless brand.  We need to think  “less is more” (new regime).

 

Lastly, let’s not forget the genesis of the most powerful marketing-the “stories’ that develop thru the interaction of a patient and their physical therapist.

 

Thoughts?

 

Larry@physicaltherapist.com

 

 

Closing out 2007!

Evidence in Motion would like to extend our sincere thanks for the loyal committment of the rapidly growing EIM family during 2007! Your numerous emails, blog comments, and avid participation on MyPhysicalTherapySpace are an immense encouragement to our profession's future in the abstract sense, but to us individually in a much more personal way. It is very clear that given the disaster of the current US health care system, particulary with respect to the management of musculoskeletal conditions, physical therapists will hold an increasingly important role in the delivery of health care in 2008 and beyond. As we have said from the beginning, our best days remain ahead because of passionate PTs who give a rat's rear end about the outrageous costs of managing musculoskeletal conditions (back pain still getting worse), the health and well being of the individual patient sitting in front of you, and elevating of the profession of physical therapy in general. We look forward to continue "stirring the pot" with you in 2008.

To recount just a bit of 2007, it was an incredibly busy year at EIM. We launched the EIM Orthopaedic Residency and Orthopaedic Manual Physical Therapy Fellowship, started the Evidence Express, hired a full time CEO in George "Pacman" Burkley, and acquired a great occupational health care company in Fit for Work (Tom and Keith, you are still OTs, but we will forgive you:)), among numerous other activities too numerous to mention here. One of the highlights of 2007 was the re-organization of our professional association, which we think is moving into positive territory. John Barnes, thanks for your leadership. We look forward to working with you.

As a token of our thanks, enjoy a little EIM "Elf Yourself" at our expense.

We wish you and your families a joyous and blessed Christmas and Happy New Year! Stay tuned for great days ahead in 2008. Don't hesitate to let us know if there is anything we can do for you.

George, John, Rob, Larry, and Tim

Giving Thanks & A Holiday Wish List

It's the holiday season and the time is ripe for a holiday-related post!  Thanksgiving is a time to give thanks, so what do physical therapists have to give thanks for this year?  How about:

1.  Bountiful clinical research productivity

2.  The DPT transition in educational programs and rapid adoption of the tDPT degree

3.  The APTA's new CEO

4.  Growing numbers of Residency and Fellowship programs

5.  Podcasts, videos, and re-designs offered by our journals; and blog readership and writing, as more PT's exchange information via the collaborative web.

 

Whatever your celebratory affiliation is, gifts are somehow involved in December; and the season is upon us.  What are some things that might fall on physical therapists' wish list?  Here is mine:

1.  Not just autonomous practice, but true ownership of our profession through phasing out of referral-for-profit arrangements.

2.  License to utilize radiological imaging in clinical practice.

3.  A profession-wide, rapid shift to a clinical education model that more closely resembles the medical model.

4.  Abolition of the CAP.

5.  Freedom from legislative assault

Leave some comments about what you might be thankful for...or are hoping for as the new year approaches!

Happy Holidays!

ERIC

image by Robert Lynn

Data that we should capitalize on

The US Population is expected to grow 25% between now and 2025

Nearly one-third of all doctors are over the age of 55

Almost no new medical schools have been opened in the US in the past 25 years

These and a a few other gems were cited in yesterdays USA Today opinion article, US Savior: Foreign Doctors which also cites the difficulty in getting medical schools up and running (note for file:  PT schools are grossly more inefficient than medical schools).

I don’t think anybody would question the demographic and statistical trends that health care will be in much higher demand in the next several years.  Their is ample reasons to suggest that we will have a significant shortage in physicians to meet this demand.  If we play our cards right, physical therapists should be well positioned to help meet this demand.  We need a campaign that highlights PT’s as musculoskeletal experts and highlights  direct access to PT’s for those conditions. 

Let’s continue to encourage health plans to charge a large co-pay for their beneficiaries that go to primary care for LBP and waive it if they go directly to a PT.

Let’s continue to highlight great articles like this that appeared in yesterday’s Desert Dispatch by a physical therapist.

 

Larry