Thursday, January 31, 2008

The Physical Therapist Identity Crisis

Tim Flynn, PT of the Evidence in Motion gang has written a terrific editorial in the most recent issue of Manual Therapy regarding the plethora of designations currently being used by Physical Therapists.

I agree with his premise that the use of these ego massaging alphabetic designations can lead to confusion for the health care consumers.  How is a consumer going to determine which of these designations have meaning for them and the credibility of the credential.  Which designations are hard earned and which are only cereal box top credentialing programs with no credibility?  There is also the issue of various professional licensing boards and the use of non-approved professional designations.

With all of the recent discussion regarding the marketing and branding of Physical Therapists and how do we do so in a way that encompasses all of the various specialities, subspecialties and practice settings, perhaps Tim has come up with an answer or at least a starting point by the following statement:

"We are not defined by our techniques or our numerous certifications, rather we are defined by our unique body of knowledge and our perspective on managing the musculoskeletal

Do we really need more?

P.S. This month's Manual Therapy is available in Full Text and congratulations to Tim on his appointment to the Manual Therapy editorial board.

Monday, January 28, 2008

Health Insurance Co-Payments Studied

A story From United Press International Health insurance co-payments studied stated

"The message is simple and it's startling -- a small co-payment for a mammogram can lead to a sharp decrease in breast cancer screening rates," said Dr. Amal Trivedi, lead author of the study. "Co-payments as low as $12 deter women from getting mammograms. Because mammograms are critical in the fight against breast cancer, the most common cancer among American women, our findings have important health policy implications."

Kind of flies in the face of co-pays as a control mechanism for over-utilization rather than a control mechanism for utilization. I wonder what those $50 co-payments mean for those who may need a Physical Therapist?

Also makes one wonder what "Coverage" means these days.

Saturday, January 26, 2008 | 01/26/2008 | Physical therapy clinics feeling the pain

This article which I received via Google Alerts Physical therapy clinics feeling the pain points out a number of the challenges faced by Physical Therapists and particularly those in private practice.  I do have to comment on a couple of comments by Mr. Dave Mason, APTA Vice President of Government Affairs and Reimbursement Advocacy.

Mr. Mason reportedly stated "It is a very competitive marketplace, where payment rates are causing pressures".  This statement is inherently misleading.  It assumes that free market influences are at work in the physical therapy marketplace when nothing could be further from the truth. 

I believe a more correct statement would have been, "It is a very anti-competitive marketplace characterized by laws and regulatory policies which are biased to the advantage of insurers, consolidation of the insurance marketplace, the rise of third party "Organized Delivery" intermediaries who represent multiple insurers and Referral for Profit.

Consolidation of the insurance industry, biased regulation, and the Organized Delivery Entities result in less competition amongst insurers to attract network providers.  Allows insurers to "negotiate" contracts with a "take it or leave it" stance thereby allowing them to reimburse at rates which make practice unsustainable. 

Additionally because of Physical Therapists failure to protect and enforce their ownership of the practice of Physical Therapy, others are employing parasitic business models as reflected in the burgeoning number of referral for profit situations across the country.  Referral for profit eliminates a patient's choice of providers, increases utilization as pointed out by a recent Medicare report and reduces the financial resources available by practicing Physical Therapists to reinvest in the profession by supporting research, their professional Associations and Societies.

I also take issue with Mr. Mason's reported comment "The practice models (therapists) had are not really working now."  This comment whether taken out of context or not I feel reinforces the continuing impression I have that the APTA would rather capitulate to the strong arm tactics of the insurance industry rather than forcefully advocate for a fair and reasonable reimbursement.  The continued focus of the Association on alternative models including "cash based practice" is a prime example of capitulation.  If "cash based practice" is the alternative model I'd ask where this leaves those healthcare consumers who pay premiums and can't afford a "cash based practitioner"  We and our patients deserve better.

How long before we all make a stand to protect and defend our practice and our profession?  I hope soon before it's too late.

As President Kennedy said, "There are risks and costs to action.  But they are far less than the long range risks of comfortable inaction"

Thursday, January 24, 2008

Transparency or Collusion

I ran across this story ( and a thought suddenly struck me after having read any number of other similar stories about other insurers.

Insurers can apparently post their fees which they pay for services on the Internet. Thereby allowing patients and other insurance companies to see what they are paying for any particular service or procedure. In this way the insurers can gather this data and adjust their fees to the lowest common denominator. Today this is called “Transparency” I guess.

If the providers were to share their fees amongst themselves this would be called “Collusion” in apparent violation of the Sherman Anti-Trust Act.

I hope this insanity ends while there are still a medical provider or two still in practice because at this rate there will be nobody left to treat the public. Of course then healthcare costs will plummet to zero which I guess is the ultimate objective of this medicine or in our case therapy death spiral.

Tuesday, January 22, 2008

Zotero - The Web Now Has A Wrangler

For those who are like me who enjoy finding pertinent journal articles and abstract and like to save information but have difficulty keeping it organized a great new tool has arrived. Zotero is essentially a high powered citation and note manager but the advantage is that it is fully integrated into the FireFox web browser. You use it with a MS Word or Open Office Plug in for developing your own papers as well. Oh and by the way it is FREE.

Here is the Online Tour if you wish.

Friday, January 18, 2008

NPA Think Tank: How representative are blogs?

Well, I've decided to take the plunge and resurrect this blog which has lain by the wayside for way too long. In response to the the challenge issued by in this post NPA Think Tank: How representative are blogs? by my colleague Eric Robertson, PT.

I'm taking up the gauntlet and will try to be diligent in the effort to combat quackery, mis/disinformation while at the same time promoting a more scientific rational approach to issues which I find relative to my practice whether directly or even sometimes slightly tangential.

Only time will tell how well I live up to the challenge as I've taken up the gauntlet. At least in the meantime, I have a place to rant and rant I can do.

Sunday, January 13, 2008

Preserving a Fundamental Sense: Balance - New York Times

Preserving a Fundamental Sense: Balance - New York Times

This is a very good article for health care consumers to raise their awareness of an issue important to safety and well being. Many conditions such as hip fracture and a host of others result from poor balance. Perhaps even more importantly a balance screening exam that demonstrates problems in this area may uncover more serious conditions that require medical attention.

Your Physical Therapist is the perfect person to assess your balance and make the appropriate recommendations.