The Physical Therapy Etcetera Blog

Moving Day!

2009-03-23T07:13:00.001-07:00

It has been fun while it lasted but thanks to an invitation from my physical therapist colleague Dr. Eric Robertson, I will now be doing my Physical Therapy related blog authoring at www.npathinktank.com (soon to be ptthinktank.com). We will also be joined by fellow colleague and blogger Roderick Henderson, PT for what should be topically varied content relevant to our profession from various perspectives.

I hope you will follow and join us at this new virtual water cooler as fellow community members and stakeholders in our future as physical therapists. I’m looking very forward to what should be an informative, enlightening and occasionally even entertaining venture with my fellow bloggers and colleagues.

The “Socialized” Practice – Part II

2009-02-08T17:42:00.001-08:00

With the advent of the various Internet social networking mediums on the world wide web such as Facebook, MySpace, Orkut, and a host of others combined with other communication tools such as blogs, Twitter, Friendfeed and others, the challenge for any professional or in this case physical therapists is to find a way to effectively use these tools to promote their practice and communicate with their patients and/or clients.

Scott Shreeve, who founded Medsphere Systems, coined the term “Millenial Patients” and described them as “defined by their behavior rather than their age, sex, or demographic. He goes on to describe how they utilize the Internet for almost every aspect of their daily lives to “meet their personal, social and professional needs.”

This group of people, the so called millenial patients, are not interested in an authoritarian, top down relationship from a professional such as a physical therapist or physician. They are far more interested in finding a trusted partner with whom they have an ongoing relationship “based on trust, mutual respect and open communication” according to Shreeve.

My experience leads to me to strongly agree with this paradigm and therefore makes me wonder how I can best serve these patients. I believe that the answer lies within the integration of the various communication tools available through the Internet including email, social network sites such as Facebook, Twitter, Skype, and website based discussion forums into our practices. The challenge will be determining best practices in the integration and utilization of these amazing tools and I think perhaps the best tool currently at my disposal might just be TxXchange. (A disclaimer: I do not have any financial involvement with TxXchange other than as a customer.)

In the third party of this series I will look at how I am envisioning the use of the aforementioned tools and particularly TxXchange in tackling some of the challenges of modern practice.

The Socialized Practice - Part I

2009-02-06T11:08:00.001-08:00

With the advent and evolution of “the web” that part of the Internet that most people see as “The Internet”, the previously held notion that all information was proprietary and commoditized has been supplanted by the notion that information should be free and open and the normal socioeconomic barriers that determine who knew what have been shattered in the phenomenon frequently referred to the democratizing effects of information on the Internet.

Professionals who previously held tight control on information within their domain, whether it was lawyers, physicians, physical therapists or any other profession, need to recognize that their closely held treasure trove of information is no longer their proprietary commodity to be doled out at a price they solely determine.

Citizens can now look up medical conditions, treatments, drug trials, laws, regulations, court filings, contracts, rehabilitation regimens or practically any other information that is able to be printed or disseminated in some form of media as it all eventually ends up freely available on the web somewhere.

If we stipulate that information is not the proprietary commodity it once was and is likely never to be again, what value do professionals bring to the table that consumers will be willing to pay for? Simply it is Expertise. Expertise is not easily or quickly acquired. It is an accumulation of skill, knowledge and experience.

The question then becomes how does one market expertise versus knowledge. In my next post we will examine some tools and potential tools to address this issue.

New Blog Category: Cases!

2009-02-06T06:39:00.001-08:00

After reading a Twitter post from a physician twitterer who commented that he has posted far more cases to his blog than he would have ever have considered submitting for publication in a more mainstream journal I had an idea.

What the heck, why not do it myself when one of those very interesting cases comes along? So the next time one of those cases comes along, I’ll share. Who knows? It might just help someone else in the process.

Just When You Thought You Were Safe From Outsourcing Because You Are in Healthcare…

2009-01-23T13:41:00.001-08:00

Apparently the safety of the notion that healthcare providers are practically immune from outsourcing overseas is being challenged if not crushed. Note this article from medpagetoday.com have long clung to International Medical Trade Turns Big Business.

According to the article in India alone revenue from so called “Medical Tourism” rose from $264 million in 2000 to $4.07 billion (yes that is BILLION with a B) in 2005.

This will be a trend worth watching.

Physiopedia – A Challenge

2009-01-22T11:04:00.001-08:00

I have had many conversations recently with those noting a dearth of openly available information directly related to Physical Therapy particularly when looking for information in the Physical Therapist’s voice. Like many issues in our profession, many complain but nobody does anything. To my relief Physiopedia is finally looking to do something about it and looks to resolve that issue.

While there is no shortage of information regarding conditions commonly treated such as ACL injury or Lower Back Pain there is a serious lack of information written in the Physical Therapists voice or that adequately demonstrates the wealth of information that comprises the unique knowledge base of Physical Therapy. What information that is available is shielded by a legacy and in my opinion outmoded and outdated system of "by subscription only” scholarly journals.

I would urge our colleagues, particularly those who possess a unique and credible expertise in particular Physical Therapy subject matter to start or at least contribute to entries in the Physiopedia Wiki such as this entry on The Glenohumeral Joint started by Tyler Shultz, PT.

By building this open and freely available compendium of information we will demonstrate the uniqueness, credibility and value to the world, and perhaps raising the visibility of our profession just a notch higher.

My thanks to all involved with the Physiopedia project. It is a project deserving of our time and contributions.

WSJ Story Pulls Back the Veil of Woo Surrounding Complementary Alternative Medicine (CAM)

2009-01-06T08:24:00.001-08:00

Steve Salerno does an excellent job in his Wall Street Journal (WSJ) article The Touch That Doesn’t Heal. In this article he points out some of the myths surrounding treatments that are not grounded in science and exposes them to the skeptical treatment they so deserve.

He also exposes how these pseudoscientific treatments are then passed on to insurers using rather dubious and self serving interpretations of the Current Procedural Terminology codes used to bill third parties for medical services.

This is an article well worth reading and should serve as a wake up call to the third party payer community who should be far more concerned with reducing true fraud and abuse rather than arbitrarily reducing reimbursement to all providers across the spectrum.

Well done Mr. Salerno and let’s hope that policy makers now endeavoring to clean up the mess that our healthcare system has become take notice.

New Kid/Journal on the Block

2009-01-04T17:31:00.001-08:00

Friday January 2nd, 2008 I received what has turned out to be a pleasant surprise in the mail in the form of a free copy of a newly published journal Sports Health. They must have known my birthday was coming up the following day.

This particular journal is published with an emphasis on “A Multidisciplinary Approach” and is a collaborative publication of the American Orthopaedic Society for Sports Medicine, North American Society for Sports Medicine, National Athletic Trainer’s Association and the Sports Physical Therapy Section of the American Physical Therapy Association.

The Table of Contents is divided up based up the discipline. The Sports Physical Therapy articles were solidly written and similar in quality and content as what is typically found in the Journal of Orthopedic and Sports Physical Therapy. The focus on this particular discipline content was on ACL treatment including the article I found most interesting by Hurd, Axe, Snyder-Mackler describing Management of the Athlete with Acute Anterior Cruciate Ligament Deficiency (ACL-D). This article goes into excellent detail in the use of a treatment algorithm developed at the University of Delaware.

I find this publication interesting in the multidisciplinary approach and frankly I think that this will further enhance the collaborative and collegial relationship that should exist between physicians and physical therapists. Perhaps it will help to shine a light on the significant contribution of physical therapists to the body of knowledge in the management of orthopedic conditions for physicians.

So thank you the thoughtful person who sent me this early birthday gift and I think it will even be worth the dues to join the Sports Physical Therapy Section of APTA.

Health Care Policy and the Next US Administration

2008-12-30T17:42:00.001-08:00

Very interesting lecture from the MIT World Distributed Intelligence program from Jonathan Gruber. His perspectives are interesting and based on much of the experience with the Massachusetts mandated health insurance program.

Treatment Exchange Part I, The “Unboxing” and First Impressions

2008-12-19T13:42:00.001-08:00

Being the quintessential “early adopter” that I am I couldn’t resist the temptation to give Treatment Exchange a whirl particularly after a fairly impressive initial online demo.

Treatment Exchange is a new online Application Service Provider (ASP) which provides an interactive home program management solution for Physical Therapists and Occupational Therapists. We are all aware of the various home program systems available that consist of essentially basic line drawings or stick figures or the simply hand drawn pictures that therapists provide to patients. We are also all aware that compliance with this system is extremely poor.

Treatment Exchange seeks to solve many of the inherent problems of Home Program Management. First, instead of simple static line drawings, it uses color pictures, usually available as animated slide presentations or video, with accompanying instructions. Second, all materials are fully customizable by the clinician. Third and probably most important this system is fully an interactive experience between therapist and patient. Integrated into Treatment Exchange is a two way messaging system that helps to insure compliance. It also provides for ongoing contact which one can only imagine will not only improve compliance but also improve patient retention both over the short term and the long term.

Screenshot of the Therapist Home Page showing Message Log for all messages between Therapist and Patient.

Screenshot of Patient Database Listing

While we have only just “gone live” with this system, it has already been well received by my patients, the operation is fairly intuitive after a 90 minute initial online tutorial and the screens are easy to navigate.

I will continue with a further review of this product, but suffice it to say I am very impressed with the product and customer service. Part II of this series will focus a bit more on the specifics of the product.

With dwindling reimbursement and looking for ways to make health care dollars go further this could be “The Next Big Thing”.

Physiopedia is Looking for Help

2008-12-18T07:27:00.001-08:00

An ambitious project has been launched to create a Wikipedia style compendium of Physical Therapy articles and information at Physiopedia. My colleague Rachel Lowe, PT is looking for ways to get our colleagues to contribute. First step is to spread the word and take it viral and this is my contribution.

If you would like to help create a credible source of Physical Therapy information that will increase the visibility of our profession and our unique knowledge base the Physiopedia is the place to start. Join them and help to spread the word.

Deja Vu All Over Again – Where Have all the …Gone?

2008-12-11T17:06:00.001-08:00

As I was reading this article from the NY Times today and put it on Twitter earlier today I had a strange sense of Déjà Vu. Probably because it reminded me of this earlier post on my blog.

I have an sense of impending crisis in healthcare that will be reminiscent of the recent bailout of the financial institutions and the possible bailout of the automotive industry. The only question will be who will bailout medical providers? Sadly this is a crisis that if not solved soon will require a much more lengthy period of recovery as the education and training of medical providers takes years so the recovery curve is likely to be extraordinarily lengthy.

Saying “Thanks!” a Little Differently this Holiday Season

2008-12-06T08:12:00.001-08:00

My Partners and I have decided that instead of doing the typical holiday routine of delivering fruit baskets and treats to express our gratitude to our many referral sources, this year we will be making a cash donation to the local food bank or Toys for Tots in their name. The choice of charity will be theirs.

To our many referrers, thank you for the opportunity and privilege of serving our mutual patients in 2008.

Insurers Propose Universal, Centralized Healthcare

2008-12-04T11:47:00.001-08:00

According to this story from the LA Times America’s Health Insurance Plans, a trade group representing the insurance industry has made a significant proposal regarding Universal Insurance. As this debate ensues everybody is going to have to make sure that what inevitably arises doesn’t provide Universal Insurance accompanied by Universal Non-Coverage.

Consumers should be assured that their benefits provide reasonable payment to providers so that providers will participate in the plans, that coverage determination will be based on necessary and appropriate provision of services without arbitrary and capricious caps or limitations based solely on the profit motivations of the private insurance carriers.

While there is tremendous even dire need for reform in Healthcare it needs to be accomplished by thoughtful, deliberate and circumspect means. A rush to a final proposal will only complicate the already complicated and failing system currently in place.

Half of Would Leave ???

2008-11-18T08:03:00.001-08:00

This article from CNN reports on a recent survey revealing that half of all primary care physicians surveyed would leave their profession if they had an alternative. While this statistic may be shocking to those outside of the medical community it probably comes as much less a surprise to those within the community. As we continue to witness the death spiral of declining third party reimbursement from insurers while all costs of practice are rising it has become increasingly difficult for medical providers to maintain a sustainable practice.

At what degree of Crisis will we recognize that the current model of third party payment is failing and that it has to be corrected soon or we will once again reap the punishment of failing to recognize impending failure of a national system?

CMS Testing Multiple PHR’s

2008-11-13T10:29:00.001-08:00

An interesting post on zdnet discusses some of the goings on with regard to CMS and online PHR systems. You can read the post here at Medicare Tests Multiple PHRs including Google.

Understanding and Ownership

2008-11-12T08:55:00.000-08:00

Those that know me well and follow my various blog postings know that I am an adamant advocate that ownership of Physical Therapy services should solely be held by Physical Therapist licensees. When one considers the myriad of problems and recent scandals impacting our profession including aberrant billing patterns and some that are outright fraudulent and the depth of ignorance regarding almost all practice related compliance it should be a shocking experience.

I think the explanation of this situation and perhaps the single best defense of my position is summed up best when over one hundred years ago Upton Sinclair wrote "It is difficult to get a man to understand something when his salary depends upon his not understanding it." Those who operate services as non-licensees are outside the reach of licensing boards and are thusly unable to be held accountable, it creates an environment whereby those licensees who work for them are at greater risk of exploitation.

Our development as a profession is fully contingent on attaining sole ownership. Abdicating ownership means abdicating control and without control we will never be fully recognized as a fully developed profession. Other professions such as physicians and lawyers have recognized this long ago and until we have embraced this concept we will continue to yearn for a recognition we don't yet deserve.

Physical Therapy and Direct Access

2008-08-13T05:50:00.000-07:00

Dr. Eric Robertson of the NPA Think Tank Blog has been writing a series of articles on Direct Access and he invited me to provide a guest commentary on the legislative efforts currently underway in New Jersey to restore some sense and reason to third party reimbursement and coverage for Physical Therapy services including direct access by consumers. You can view the series including my contribution here.

NASA Should be Just Giddy with Pride Over Recent Successes

2008-06-30T11:19:00.001-07:00

With the unmitigated and unprecedented success of the Mars Rover (Spirit and Opportunity) Program, the recent success of the Mars Phoenix probe and its discovery and confirmation of the presence of water on the Red Planet and now the successful completion of the Cassini Primary Mission, NASA should be absolutely giddy with delight over their successes. My hat is off to you NASA!

Leveling the Playing Field

2008-06-26T10:36:00.001-07:00

On June 23, 2008 the New Jersey General Assembly took the first step in restoring some sense and reason to the practice environment for Physical Therapists and healthcare consumers in the State of New Jersey by overwhelmingly passing Assembly Bill 2123 (A-2123). This landmark piece of legislation seeks to establish standards of coverage and reimbursement that are commensurate with the standards of practice by which Physical Therapists in New Jersey are bound to abide.

A-2123 assures consumers that the coverage that they and their employers pay so handsome a price for will indeed provide services without arbitrary caps on payment for services rendered or visits for medically necessary services. As we are all painfully aware, third party payment for Physical Therapy services has been in a downward death spiral. A-2123 establishes a floor of reimbursement based on an already existing PIP fee schedule established by the State of New Jersey below which the insurers' liabilities may not fall. It also provides for the elimination of capricious and arbitrary visit authorizations less than those proposed by the treating Physical Therapist's Plan of Care should authorization be sought. This legislation also makes Direct Access an affordable option for consumers by eliminating all referral requirements for third party payment for Physical Therapy. There are a host of other benefits of this legislation which are covered here.

When all else has failed there are other avenues that are available to combat the deterioration of the practice environment and the legislative arena is the one most apropos when all other avenues have failed to produce satisfactory outcomes.

The Senate companion bill of A-2123 was introduced last week as well in the form of S-2072. I for one am looking forward to the passage of this bill as well and the eventual enactment of this legislation by the stroke of the Governor's pen.

Might we see a doctors’ strike?

2008-06-20T17:05:00.001-07:00

This article from ZDNet is interestingly insightful in that it recognizes the stress currently afflicting nearly all the various medical professions. If the current trends continue or even accelerate (which I believe entirely feasible) we will all be in for a rude awakening when there is nobody left to treat us or at the very least participate in our insurance plans. Unless a reasonable methodology for compensation for medical professionals is developed Universal Health Care will be like throwing a party where nobody shows up.

Excellent Blog Post on DDD and Back Pain

2008-06-18T17:21:00.001-07:00

I won't reiterate the excellent post and commentary by Jason Harris, PT on this Blog Evidence Based Rehab. Read it for yourself Here

Physical Therapists have Bloodshot Eyes Too!

2008-06-18T12:00:00.001-07:00

This article could very well have been written about Physical Therapists. The current practice environment is like a cancer is and could be the demise of all of us.

http://www.nytimes.com/2008/06/17/health/views/17essa.html

Putting Science in Our Lives

2008-06-01T16:41:00.001-07:00

Brian Greene, eminent physicist and author of The Elegant Universe has written a wonderful Op-Ed piece in the New York Times titled "Put a Little Science in Your Life." It goes a long way to demonstrating the critically important need for improved science education and showing the importance of its standing in our culture.

Science is the method by which rational and reasoned people come to understand the universe in which we exist and our place in it.

Kudos to Dr. Greene for his elegant and eloquent commentary.

$2 Million to Play with the Wii for Rehabilitation

2008-05-29T17:54:00.001-07:00

Who says all that down time playing with video games doesn't pay off?

$2 million dollar grant for studying use of video games

Physical Therapists - Practitioner of Choice

2008-05-21T12:04:00.001-07:00

If the embedded video doesn't seem to be working properly please use this direct link to the Video Physical Therapists - Practitioner of Choice.

Congratulations to my colleagues David Bertone, PT, OCS and Ken Mailly, PT, on this terrific production.

Google Health Launches for the Masses Today

2008-05-19T12:28:00.001-07:00

Today Google has launched Google Health for the masses. One should note that there is a caveat as noted in this article from Larry Dignan's ZDNet Blog.

I plan on signing up and will offer a review after having done so.

Like Comatose Sheep to the Slaughter

2008-05-12T09:58:00.001-07:00

What is it about Physical Therapists that they take so little interest in the direction of their own profession? The American Physical Therapy Association (APTA) represents a membership of only 71,000 members of about 300,000 licensed Physical Therapists in the United States. Of its 71,000 members 5800 responded to a survey on the Association's Stategic Plan. While I applaud those who responded, it represents about 8% of the membership and less than 2%. What the heck are the other 92% and 98% respectively doing? Lying comatose in some hospital bed believing that their livelihoods are not being threatened from every possible angle imaginable?

Credit Cards and Evaporating Margins in Health Care

2008-05-08T10:48:00.001-07:00

I was just wondering to myself what direction medical providers are leaning with respect to accepting credit card payments for professional services. Considering the fact that margins have evaporated or worse are now hovering in the red with regard to third party payment for medical services, does the acceptance of credit cards and the accompanying 2-3% processing fees for co-pays and co-insurance make sense from a business perspective?

I'd be interested in how you are leaning, so please participate in our poll in the right hand margin of this blog.

Revolution Health Provider Listings

2008-04-30T10:51:00.001-07:00

I just visited Revolution Health (www.revolutionhealth.com) and realized that the provider listings they had on file for me were WAY outdated. Apparently they used a shotgun approach and listed almost every place I had worked in the past 10 years. I'd suggest a little Internet surfing over to their website and check your listing. You can make the correction request directly from their website.

If you are a Physical Therapist look under Specialists then in the Therapy-Physical category.

Cheers!

On line Reviews of Doctors Poll at CNN.com

2008-04-18T10:07:00.001-07:00

I just noticed that according to an obviously very unscientific poll of CNN.com readers of just over 100,000 poll respondents 82% reported that they do not trust online reviews of doctors. First I have to give credit to the collective wisdom of these respondents but I'd sure be interested to know why. I've always found most online reviews to be predominated by those with an axe to grind because of an isolated bad experience or some other similar reason. Satisfied customers and in this case patients are generally not as motivated to voice their opinions.

The story associated with this poll can be read at How to Find a Doctor Online

Evernote Beta Invitation

2008-04-10T13:54:00.000-07:00

I have ~~8 4 2~~ Evernote Invites to their Beta release. If anyone is interested, drop me a note, I'd be glad to invite you in to test drive.

Sorry the invites are all taken.

A Clinical/Research Track Model for Physical Therapists

2008-04-07T10:48:00.001-07:00

A story published in the San Diego Union Tribune regarding The Scripps Research Institute and their proposal to open a new medical school with a dual track for both clinical training as well as research would seem to be an excellent model for Physical Therapy education programs to consider. Considering the strong push to further the EBM model and the considerable amount of solid research being produced of late this would seem to be an opportune time to consider this same model in order to train the clinical researchers of tomorrow.

This approach would certainly go a long way toward remedying my previously expressed concerns regarding the tendencies of our profession to adopt techniques and technologies before they have been adequately vetted by researchers and demonstrated their value and efficacy.

Another PT Takes Up the Blogging Challenge

2008-04-07T07:32:00.001-07:00

Tim Richardson, PT, one of the subjects of the bradenton.com story which was previously mentioned in this blog has launched his own efforts on a couple of different websites. First, to help spread the Physical Therapy gospel he has launched a blog at www.physicaltherapydiagnosis.com and also has demonstrated one of the many ways Physical Therapists can use the power of the Internet to communicate with colleagues as well as healthcare consumers. You can view his efforts on this front at www.physical-therapy-videos.com.

On a side note I'd like to extend my appreciation for Tim's plugging of a new website which is now being launched at www.tech4pt.com. TECH4PT.com is a community based website devoted to promoting the use of technology including the many possibilities provided by the Internet to enhance the practice and business of Physical Therapy. As this site is still under considerable construction, I invite anyone who is interested to register and contribute. There are mechanisms for submitting news stories related to the subject matter of the website as well as contributing relevant web links to other sites. I look forward to this website developing as it builds its own member community. If you have suggestions on how to make the site even better please feel free to use the "Feedback" mechanism on the www.tech4pt.com website.

Wellpoint Won't Pay for Treatment Due to Medical Errors

2008-04-04T10:18:00.001-07:00

Oh boy, I can't wait to start seeing the fallout from this Insurer policy. WellPoint: 11 errors off-limits.

This looks like a real can of worms. Who is going to pay then? The patient? Considering the economic pressures already taking their toll on providers and hospitals I can't see these treatments, many of which have potential to be extremely expensive, being provided for free. Some day we are going to have to accept the fact that perfection is an unreasonable expectation and that despite best efforts, bad things happen.

Widely Used But Untested Interventions

2008-04-04T09:06:00.001-07:00

When reading this Physiospot Blog entry on Neural Mobilization it brought to mind a question I've had many times over the years. What is it about Physical Therapy that interventions become so widely used without undergoing any kind of rigorous testing or trials? Whether it is low-level laser, myofascial release, neural mobilization or anything else for that matter. We seem to willing to take it on the word of some device manufacturer or even worse some self appointed guru that their interventions work. How do we know? It sometimes seems to me that not only do PT's seem to have some innate "peace gene" but seem to have lost their "skepticism gene" somewhere along the way as well.

Can the MFR Experts Save Us From the Doom of a Black Hole

2008-03-30T10:38:00.001-07:00

I read this article Asking a Judge to Save the World, and Maybe a Whole Lot More in the NY Times today and one of my immediate rather Freudian Stream of Consciousness thoughts was that perhaps we should send in a few of the John F. Barnes Myofascial Release experts in as a safety measure since apparently they have developed an ability to manipulate the quantum properties of matter. Just a tongue in cheek thought.

The Should've Been Once and Future President? Gore 2008?

2008-03-30T09:25:00.001-07:00

Within the continuing and contentious debate between the Clinton and Obama campaigns on their respective candidate's path to the White House in 2008 there lies a path to the White House for Al Gore who won the popular vote but lost the White House due to the idiosyncrasies of the Electoral College and the meddling of the Supreme Court.

Should the two leading Democratic contenders continue in their current tactics and ultimately damage either of their chances in defeating the presumptive Republican nominee Senator John McCain it is possible that Al Gore could be the inevitable nominee of the Democratic Party.

This is possible only if the uncommitted Super Delegates to the Democratic Convention recognize they have either the unenviable position of playing the role of the 2000 Supreme Court and deciding between Clinton or Obama and thereby risk disenfranchising the sizable contingent of strong supporters for one or the other or they simply sit out the balloting until all delegates are no longer committed. At that point it is conceivable that Al Gore could be cast in the role of the White (Green?) Knight to save the party. Should either Clinton or Obama fail to win and then in an open convention ballot be nominated and be the resultant Democratic nominee. This could also potentially alleviate the Michigan and Florida problem if the convention rules committee were to allow for the seating of these delegations should the possibility of an open ballot arise.

Of course this scenario would become moot if the two members of what would constitute the Democratic Dream Ticket would simply resolve among themselves which of the two were to head the ticket and which would settle for being the Vice Presidential nominee.

The Purveyors of "Woo" and the Wellness Space

2008-03-28T10:37:00.001-07:00

We should all find it unsettling that the purveyors of Woo and pseudoscience seem intent on taking over the "Wellness" space. This story Do Gooders on the Internet Intent to Focus on Wellness from Techcrunch should cause us all a little discomfort. As the experts in movement and function this should be the space that Physical Therapists dominate.

BBC Eliminates Complimentary Medicine Pages from Health Website

2008-03-27T05:22:00.001-07:00

Well score one for the rational world. The BBC has removed the Complimentary Alternative Medicine (CAM) pages from their Health Website. Some of the ludicrous claims of the CAM community outlined in this blog post from DC's Improbable Science Blog probably point as to why this decision was made. Hopefully this is a trend that will continue.

Potential Tools to Combat the Fringe Element

2008-03-24T06:22:00.001-07:00

David Gorski, MD, PhD, has written an outstandingly insightful piece on the Science Based Medicine Blog titled "When impressive science fails to impress patients" He touches on salient points as to why some patients may ignore scientifically supported recommendations regarding treatment which I believe also has relevance to those who will accept the pseudoscientific treatment methods of certain fringe elements.

This article should provide sufficient insight on how best to arm ourselves to approach patients who may be considering certain unreasoned approaches of Complimentary Alternative Medicine (CAM) as opposed to the effective and scientifically based approaches that may be recommended.

I look forward to further discussion in how the principles outlined in Dr. Gorski's article may be utilized.

The Ignorance of Fundamentalist Belief - A World Going Mad

2008-03-23T09:09:00.001-07:00

File this post under the "Etcetera" nature of this blog.

This weekend while watching the ABC World News Tonight my sense of reason was rudely assaulted by this piece on yet another Creationist Museum or as they term it "Biblically Correct". The children who are being so wrongly misled in this news item remind me of the children who find themselves in the radical Islamic Madrassahs. They are being indoctrinated with fundamentalist archaic beliefs that no longer have relevance in a reasoned scientifically enlightened world. I find it ironic that these same fundamentalist Christians are probably the same people who rail so incessantly against the Muslim radical fundamentalists. It seems to me they are the opposite side of the same wrongful coin content to live in ignorance and conflict with all that is reasonable. Conflicts of culture and nationalism will only be resolved when relativistic and dogmatic belief is replaced by reason.

Where Have All Flowers Gone? A New Verse?

2008-03-16T14:31:00.001-07:00

As I commented to a friend the other day, unless something changes soon with respect to the current medical practice environment, in the not too distant future people are going to wake up and wonder where have all the medical people gone. I guess it could be a new verse to the old Pete Seeger tune.

Perhaps this story below is a presage of what might be.

Doctor shortage takes a toll in Japan from PhysOrg.com
Japan might boast universal health cover and some of the world's best medical technology, but an acute shortage of doctors is leaving some hospitals unable to treat even car crash victims. [...]

Observations From the Precipice

2008-03-16T09:27:00.001-07:00

This week I was disturbed by some continued trends in the downward spiral of our health care system and this is a bit of just rambling tid bits but I find it all somewhat disturbing as an illustration of what is amounting to healthcare these days.

First, I had the privilege of seeing a gentleman this week following a fracture of the proximal humerus and radius. While these are not atypical conditions seen everyday in Physical Therapy clinics across the country what was disturbing was his difficult navigation of the health care system prior to arriving in my clinic. This gentleman was unfortunate enough to have been talked into being a subscriber of one of the various Medicare Advantage managed (mangled?) health care programs.

After this gentleman fell fracturing his proximal humerus and radius in is driveway as a result of impaired balance and gait as a result of his battle with Multiple Sclerosis and lying undiscovered in his driveway for approximately 2 hours in the early morning hours he was transported to the local Emergency
Room where he was assessed, diagnosed with the proximal humerus and radius fractures and then sent home in a splint with instructions to see an orthopedist for further treatment (casting). First, this caught me by some surprise but apparently Emergency Room physicians in this region no longer cast fractures and instead patients are referred to a local orthopedist for this procedure in their offices. Now this is where the complications become more apparent since there is apparently a very limited number of orthopedists who are participating in this Medicare Advantage program. So, it was not until four days after an exhaustive search by the patient and his wife later that this patient was finally casted.

A second story I was told this week was by one of my support staff. Apparently her sister had taken her three young children to a local pediatrician as they were all suffering from a respiratory infection. Well after having been seen by the physician the mother went to the reception check out desk and wrote her check for the three $40 dollar copays and then started for the exit. It was at this point that the story took an odd turn. As she headed for the door she was headed off by the front desk person who informed her that she owed an additional $120 dollars for the three office visits. After a shocked "Excuse me?" she was informed that there was a $40 per visit surcharge for being seen "after hours". I guess my question is exactly how does it qualify as "after hours" if the office is open and waiting room is full? It wasn't exactly like the pediatrician was dragged out of his bed in the middle of the night? It seems more like a gaming of the system more than anything else. Not that I'm not sympathetic to the plights of the pediatrician with respect to reimbursement but this once again smacks of the continued capitulation mentality and allowing reimbursement to drive practice.

A third disturbing story also came to light this week when a friend of mine informed me that his primary care physician now charges a $15 surcharge for a referral to a specialist if there is no office visit.

Things are bad and are seemingly only getting worse.

Anodyne Light Therapy Doesn't Ease Sensory Neuropathy in Diabetics

2008-03-04T05:33:00.001-08:00

This article Anodyne Light Therapy Doesn't Ease Sensory Neuropathy in Diabetics appearing today on Medscape sheds doubt on the purported benefits of Monochromatic Infrared Energy (MIRE) therapy using the probably best known MIRE device on the market.

This double blind study utilized a number of measures which point to a strong placebo effect but refute the claimed benefits of the device itself.

Hopefully I will be able to find the original research article for a more critical review. But in the meantime for those considering the purchase of this device I guess the phrase "Buyer Beware" should hold special meaning in this case.

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

2008-02-29T13:46:00.001-08:00

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.

Testimony on A2123

2008-02-26T05:59:00.001-08:00

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.

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

2008-02-25T14:32:00.001-08:00

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.

Testifying in Trenton Tomorrow

2008-02-24T18:17:00.001-08:00

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.

Cats and Faster Moving Matter

2008-02-22T10:42:00.001-08:00

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!

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

2008-02-20T06:50:00.000-08:00

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.

OA and Evidence Based Treatment Recommendations

2008-02-19T18:12:00.001-08:00

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

2008-02-19T04:34:00.001-08:00

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.

Clinic or Gym?

2008-02-17T05:03:00.001-08:00

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.

CUOMO ANNOUNCES INDUSTRY-WIDE INVESTIGATION INTO HEALTH INSURERS’ FRAUDULENT REIMBURSEMENT SCHEME

2008-02-15T15:16:00.001-08:00

CUOMO ANNOUNCES INDUSTRY-WIDE INVESTIGATION INTO HEALTH INSURERS’ FRAUDULENT REIMBURSEMENT SCHEME

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

Health insurers probed over reimbursement

2008-02-13T13:33:00.001-08:00

Health insurers probed over reimbursement

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

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

2008-02-12T18:52:00.001-08:00

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.

Healthcare missing a key ingredient -- the care

2008-02-11T10:13:00.001-08:00

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.

Happy Birthday Mr. Darwin

2008-02-10T05:49:00.001-08:00

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.

The Physical Therapist Identity Crisis

2008-01-31T04:42:00.001-08:00

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
system."

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.

Health Insurance Co-Payments Studied

2008-01-28T19:41:00.001-08:00

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.

Bradenton.com | 01/26/2008 | Physical therapy clinics feeling the pain

2008-01-26T20:38:00.001-08:00

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"

Transparency or Collusion

2008-01-24T10:28:00.001-08:00

I ran across this story (http://www.charlotte.com/business/story/453230.html) 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.

Zotero - The Web Now Has A Wrangler

2008-01-22T18:52:00.000-08:00

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.

NPA Think Tank: How representative are blogs?

2008-01-18T07:27:00.000-08:00

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.

Preserving a Fundamental Sense: Balance - New York Times

2008-01-13T14:21:00.000-08:00

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.

Depression unrelated to level of chronic pain - Yahoo! News

2005-05-30T12:01:00.000-07:00

PhysioCare Physical Therapy: Pain and Your Brain

2005-05-21T19:11:00.000-07:00

PhysioCare Physical Therapy: Pain and Your Brain

Early Quadriceps Strength Loss After Total Knee Arthroplasty. The Contributions of Muscle Atrophy and Failure of Voluntary Muscle Activation -- Mizner

2005-05-14T17:17:00.000-07:00

Early Quadriceps Strength Loss After Total Knee Arthroplasty. The Contributions of Muscle Atrophy and Failure of Voluntary Muscle Activation -- Mizner et al. 87 (5): 1047 -- Journal of Bone and Joint Surgery

Arthritis Symptoms Worse in African Americans - Yahoo! News

2005-04-29T13:41:00.000-07:00

Arthritis Symptoms Worse in African Americans - Yahoo! News

Exercise as Good as Surgery for Shoulder Injury - Yahoo! News

2005-04-26T15:13:00.000-07:00

Exercise as Good as Surgery for Shoulder Injury - Yahoo! News

Variety of Exercise May Ward Off Dementia - Yahoo! News

2005-04-26T12:13:00.000-07:00

Yet another advantage of a variety of exercises in a program of general fitness.

Variety of Exercise May Ward Off Dementia - Yahoo! News

Yahoo! News - Seniors Take Up Tai Chi, Yoga Across U.S.

2004-09-26T15:42:00.000-07:00

An interesting article on the benefits of Tai Chi.
Yahoo! News - Seniors Take Up Tai Chi, Yoga Across U.S.

First Post

2004-09-25T14:08:00.000-07:00

This is the first post to The Physical Therapy Blog. This blog will provide news and personal opinion regarding issues concerning Physical Therapy including clinical, administrative and related issues.

I hope that readers find it of interest whether they may agree with me or not.