0 comments Monday, April 14, 2008

As baby boomers begin to retire, the faults of Medicare are beginning to be easily exposed. For years has been trying to control costs, not be rewarding and expecting efficient evidence based care, but by micromanaging, cutting reimbursement, and rewarding the over use of meds, imaging, and surgery. A great example of this is CMS' assertion that the arbitrayr cap on out patient PT services ONLY, is doing it's job and keeping costs down. Larry Benz over at Evidence in Motion does a fantastic job of outlining the fallacies in this claim. Basically, it's down becuase PT's are scared to death that we wil be punished for fully treating when needed (ie we bail on the pt once the cap is in sight).

In an article from MSNBC, a report from the National Academy of Sciences found:

  • There aren’t enough specialists in geriatric medicine.
  • Insufficient training is available.
  • The specialists that do exist are underpaid.
  • Medicare fails to provide for team care that many elderly patients need.

It's easy for Medicare to pick on the group with the smallest voice. In the end, though, I believe it will lead to poor outcomes and a return back to inflating costs due to invasive procedures and imaging.

0 comments Tuesday, April 8, 2008

A press release from the American Association of Oral & Maxillofacial Surgeons discusses a bill that would allow them to refer patients to physical therapy. Currently only osteopathic (DO's) and allopathic (MD's) doctors may "oversee" (read: sign the ok for) physical therapy.

Oral & Maxillofacial surgeons and other dentist make the case that they routinely treat patients that would benefit from PT, therefore having the ability to do so would be beneficial:

As Congressmen Pascrell and Cantor noted in sponsoring the bill, because a dentist or OMS cannot directly refer patients for physical therapy, they must refer patients to an allopathic or osteopathic physician to establish a therapy plan. In his statement of introduction on the floor of the House of Representatives, Pascrell stated, Such consultation has proven to be inefficient, unnecessary and cumbersome, and it ultimately delays patient treatment and the continuum of care.

I agree. But I'll take it one step further. It is just as "inefficient, unnecessary and cumbersome" for patients to have to go to their MD, DO, DDS in the first place for neuromusculoskeletal rehab. True full direct access to physical therapist - the experts in neuromusculoskeletal conservative care - would greatly decrease time to recovery and the extraneous costs of medications and excessive imaging associated with going to multiple physicians before getting to see a physical therapist.

Jason L. Harris

0 comments Monday, April 7, 2008

I wanted to share a nice resource I recently found on the internet. It is an online publication of the book "Back Care Boot Camp" which covers many educational aspects for patients on low back pain. The online (free) version appears to leave nothing out in terms of what the book offers to the patient. You can also purchase an ebook version or have a patient purchase an individual section to print. Each section costs only $1.00 and the whole ebook in $4.95.

This appears to be a very nice resource to supplement you patient education and re-emphasize important topics covered in a patients clinic visit. Check it out and let me know what you think.

Jason L. Harris