Friday, February 29, 2008

Does APTA Stand Behind it's Positions Or Is It All Rhetoric?

Well today I was one of the tens of thousands of recipients of the PT Bulletin email which in which was noted "This PT Bulletin sponsored by: US Physical Therapy".

A short visit to the US Physical Therapy web site and you will find the following:

U.S. Physical Therapy, Inc. ("USPh" or the "Company"), which was founded in 1990, is a publicly held company which operates approximately 350 outpatient physical and/or occupational therapy clinics in 42 states across the United States. The Company's clinics provide post-operative care for a variety of orthopedic-related disorders and sports-related injuries, treatment for neurologically-related injuries, rehabilitation of injured workers and preventative care. In addition to owning and operating clinics, the Company manages several physical therapy facilities for third parties, including physician groups.


Now while I've always found their claims of offering Physical Therapists "partnerships" and that it somehow was "private practice" a bit dubious, the fact that this same company promotes referral for profit practice settings seems to fly in face of our Association's position regarding the same.

This then seems to beg the question why would our Association would allow advertising and accept payment for the same in the Association's publications.  There is a word I think for this type of behavior and it has been flying around the 'Net in reference to certain behaviors.

Tuesday, February 26, 2008

Testimony on A2123

For those that may be interested.  Here is the testimony on A2123 before the Insurance and Financial Institutions Committee of the New Jersey General Assembly.

Monday, February 25, 2008

A2123 Passed by Insurance and Financial Institutions Committee of the New Jersey General Assembly

I'm very pleased to say that A2123 was passed today by the Insurance and Financial Institutions Committee of the New Jersey General Assembly.  This bill when enacted will provided for substantive consumer and provider protections with respect to coverage and reimbursement.

Sunday, February 24, 2008

Testifying in Trenton Tomorrow

Tomorrow I will be in Trenton, NJ to testify before the New Jersey General Assembly's Insurance and Financial Institutions Committee in support of Assembly Bill 2123.  This bill if passed will restore some reason and sanity to a reimbursement system run amuck in New Jersey as well as ensure the continued access to services for New Jersey Consumers.

Friday, February 22, 2008

Cats and Faster Moving Matter

Although I will make every effort possible not to blog on other blogs it will happen from time to time simply because I read so darn many.  So I have to relent and continue comment on an ongoing discussion over at the Evidence in Motion Blog.  There is a vigorous discussion and dialogue on a post titled Myofascial Release - Time to Stop the Madness.  It has turned into essentially the well reasoned and rational versus the unreasoned and irrational. 

The foundations of science are built upon reasoned inquiry, observation, measurement, and conclusions.  When others forego reason substituting desire and imagination, the end results utterly lack credibility.  And no matter how many obscure scientific principles are misapplied their declarations and positions are nothing more than science fiction.  Unfortunately the unreasoned and those who do not have a well developed sense of skepticism will continue to fall prey to their nonsense. 

The best defense that we have has been and will continue to be science.  By dispelling their myths and mysticism and replacing it with hard irrefutable scientific evidence we will marginalize them.  There have been and always will be those who lack proper reason and they will continue to live on the margins.  The best we can do is to make sure they stay there.

Now one might ask about what all this has to do with the title of this post.  So I'll end with a little anecdote that this whole line of discussion brought to mind.

A number of years ago I had a friend who was and would probably always be a refugee from the 70's.  They had lived in a California commune when such things were more commonplace.  One evening sitting outside we were having a discussion that turned to her cat's behavior.  Anyone who has ever had a cat has seen their cat jump up for no apparent reason and run around the house like they were possessed.  When I asked Why do they do that?" , my friend's immediate response was "...that they could see faster moving matter."  I chuckled for a moment and then asked "Then why do they get hit by cars?"

I always attributed her thinking to one too many bad acid trips back in the day.

Forever skeptical and proud of it!

Wednesday, February 20, 2008

More Support for Physical Therapists as the First Line Interventionists for Back Pain

One of the primary obstacles to quick resolution of back pain is the medical gauntlet that many patients have to endure before seeing their physical therapist. This medical gauntlet often creates an unnecessary delay by waiting to be seen by a primary care physician, the typical course of several weeks of anti-inflammatory medications, then off to an orthopedist, then x-rays, then MRI THEN the physical therapist. By the time the patient has navigated this gauntlet of interventions mostly unsupported by the current best evidence, their condition is ingrained and the time required for resolution is dramatically increased. Nothing better demonstrates this that what has transpired at Viginia Mason Medical Center at the urging of Starbucks. This video from the local Fox affiliate should be of great interest to back pain sufferers as well as insurers and employers who bear the brunt of many unnecessary expenses in the treatment of back pain.

Here is the Video

*special thanks to the EIM folks again for bringing this to my attention.

Tuesday, February 19, 2008

OA and Evidence Based Treatment Recommendations

First I'd like to thank my colleague at Evidence Based Rehab for for bringing to my attention this document released by the Osteoarthritis Research Society International on their recommendations for treatment of knee and hip osteoarthritis. As I and many of my colleagues would have previously opined, Physical Therapy should figure prominently in the management of this disorder and based on this document the evidence is compelling. This is also consistent with the recent recommendations of the American Heart Association.

This is yet another example of the mantra now being repeated often by my colleagues at the Evidence in Motion Blog, "You got drugs, you got surgery, you got us."

A Rip-Off by Health Insurers? - New York Times

It appears that the actions by New York's Attorney General, Andrew Cuomo is gaining considerable traction based upon this A Rip-Off by Health Insurers? - New York Times, an editorial appearing today.  The monopolistic behaviors of the insurance industry and what one can only describe as collusion to deprive medical providers of reasonable compensation are now finally coming to light.  Hopefully this is only the beginning and we will see a return to reason in the practice environment.

Sunday, February 17, 2008

Clinic or Gym?

Before going on I want to preface everything by stating that we take great pride in our offices.  They are clean, well appointed, carpeted with the usual arrange of treatment tables, treadmill, stationary bike, total gym, strap on weights and dumbbells all in approximately 1200 square feet.

Having stated that, yesterday I was speaking on the phone to a potential patient who had previously dropped by our clinic but wanted a little more information.  He immediately stated that he was coming because of our reputation in the community as very good clinicians but was unimpressed by the physical facilities.  He then went on to explain that he had been going to "physical therapy" for most of the last 11 years  under a "doctor's prescription (maybe that says a lot).  After having taken a moment since I was a little taken aback as you might imagine, I asked what he meant.  He went on to explain that the facility that he had attended for the last 11 years was very large and had all types of weight and exercise machines. 

I can already imagine the work ahead in educating this patient what the difference is between insurance subsidized gym membership (something I'm sure they wouldn't be too happy about if they understood the difference) for exercising and Physical Therapy.  His false expectations are obviously already ingrained but I've already started his re-education by explaining that in my experience the quality of care is typically inversely proportional to the amount of exercise equipment available.  Physical Therapy is what the Physical Therapist does, not the patient.  Doing circuit training is not Physical Therapy.

I just wonder how much damage the flight to "cash-based practice" and the proliferation of the gymnasium atmosphere will ultimately do to our profession before we realize that this is a road to nowhere.

Friday, February 15, 2008





Yup, it does appear the worm is turning.  Someone is finally waking up and realizing that there is something amiss. 

Wednesday, February 13, 2008

Health insurers probed over reimbursement

 Health insurers probed over reimbursement

Hmmm...  Maybe the worm is about to turn.

Tuesday, February 12, 2008

Health Beat: Will Consumer-Driven Medicine Really Cut Health Care Costs?

This article Health Beat: Will Consumer-Driven Medicine Really Cut Health Care Costs? in the Health Beat blog of which I'm quickly becoming a devoted fan does an outstanding job of pointing out many of the flaws in the flight to Consumer-Driven Medicine. 

While many of us experience the pain of dealing with the current insurer driven system of providing health care, some have taken flight to the lure of cash-based practice, a version of consumer-driven medicine.  Just maybe the above article will give some pause before deciding to capitulate and leaving even more profits in the hands of the third party payers to the detriment of our fellow premium paying citizens.

Monday, February 11, 2008

Healthcare missing a key ingredient -- the care

Well we should all be letting out a collective "OUCH" on this little article, Healthcare missing a key ingredient -- the care .

This lady's complaints however well founded some individual points may or may not be, point out many failings in the Physical Therapy community and practice in general. With all of the discussion on various blogs such as Evidence in Motion and others regarding marketing it seems that many if not most of my own colleagues are missing the single best marketing opportunity they will ever be presented, their own patients. What lies beneath this could be explained by the continuing prevailing mentality of allowing reimbursement to drive practice (When will we finally find the courage to made a stand and quit capitulating?) but it certainly doesn't excuse it.

I'm disappointed that the situation described in this news article will leave this particular patient with the impression that what she experienced is what she should expect. Unfortunately, this patient's therapist obviously doesn't understand her own professional branding, namely direct interaction, education, touch and astute clinical reasoning based on a unique knowledge base of human movement and function. What this poor lady experienced was none of these based on how she related her experience. My sincerest hope is that she will elect to find a Physical Therapist who better exemplifies what our practice is truly about.

Of course none of these things are helped by yet another "Wii-hab"article and somehow I doubt a few lines of Wii bowling would have improved her perceptions of Physical Therapy.

Sunday, February 10, 2008

Happy Birthday Mr. Darwin

Just in case I get too Tuesday, February 12th, I want to make sure I don't forget to extend my Happy Birthday wishes to Mr. Charles Darwin.  A man whose life always gives me hope that someday science and reason will win out over ignorance and superstition.