Evidence Based Rehab

David Straight of E-rehab has put together a website called PT's Unite to help bring about a grass-roots effort for California PT's and their push for direct access. Please consider helping in the cause. Remember, success for PT's in one state can help lead to success for you and a failure can make it harder to bring about change in your state.

Good luck to those PT's in California and thank you to David for grabbing the tourch and attempting to lead the way to change.

Jason L. Harris

Labels: Direct access, legislation, physical therapist

Richard Deyo MD, the keynote speaker at the American Academy of Orthopaedic Manual Physical Therapists (AAOMPT) National Conference in October 2008, has again published data indicting the US approach to chronic back pain dramatically increases costs without improved outcomes. Deyo and colleagues reported in the January 2009 issue of the Journal of American Board of Family Practice the following staggering statistics:

• A 629% increase in Medicare expenditures for epidural steroid injections;
• A 423% increase in expenditures for opioids for back pain;
• A 307% increase in the number of lumbar magnetic resonance images among Medicare beneficiaries;
• A 220% increase in spinal fusion surgery rates.

The incidence of chronic and acute Low Back Pain, as documented by office visits, has not changed during the last 12 years. The application of these technologies is not without consequences Deyo et al noted, ‘Innovation has often outpaced clinical science, leaving uncertainty about the efficacy and safety of many common treatments. Complications and even deaths related to pain management are increasing.’ Indeed, the reoperation rates for low back pain have increased, not improved. The authors conclude that the ‘Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain.’ They note that these approaches often are applying an acute care model to chronic pain and not acknowledging the current evidence that chronic pain requires a different approach and that there are ‘no magic bullets.’ In a “chronic care model” chronic back pain, like diabetes or asthma, ‘is a condition we can treat but rarely cure.’ Deyo et al suggest the solution that ‘chronic back pain may benefit from sustained commitment from health care providers; involvement of patients as partners in their care; education in self-care strategies; coordination of care; and involvement of community resources to promote exercise, provide social support, and facilitate a return to work.’

Tim Flynn, PT, PhD, president of the AAOMPT states, ‘The manual physical therapist is the health care provider uniquely trained to manage individuals with chronic low back pain. We utilize low risk, state-of-the-art care incorporating exercise, manual physical therapy, patient education and the application of the biopsychosocial model in managing this chronic condition. The Academy is dedicated to the application of current models for chronic pain management.’ The recent AAOMPT conference in Seattle focused on current theories and practice of chronic pain management with international experts on pain management.

Labels: AAOMPT, CPR, Direct access, evidence based medicine, health care, LBP, Low back pain, physical therapist, physical therapy

The folks over at Evidence In Motion have announce the winners of their "30 Second Elevator Pitch Contest" asking participants to answer the question:

- Why physical therapy is the best first choice in musculoskeletal care.

The grand prize winner was the entry submitted by BJ Lehecka from Wichita State University. You can see BJ's winning entry below. To see the full list of winners and other information, please go to EIM's blog found here.

Labels: Direct access, media, physical therapy, public relations

Archives of Physical Medicine and Rehabilitation recently published a study on the benefits of physical therapy for lower extremity trauma. The abstract is as follows:

OBJECTIVE: To examine the effect of physical therapy (PT) use on a range of measures of physical impairment in a cohort of patients with lower-extremity trauma.

DESIGN: Longitudinal, observational study of patients with severe lower-extremity trauma. Patients were interviewed by a research coordinator and examined by an orthopedic surgeon and a physical therapist during initial admission and at 3, 6, 12, and 24 months postdischarge.

SETTING: Eight level I trauma centers.

PARTICIPANTS: Patients (N=382) whose legs were salvaged after limb-threatening trauma to the lower limb.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Unmet need for PT was assessed from 2 perspectives: an orthopedic surgeon and a physical therapist independently evaluated each patient and were asked whether the patient would benefit from PT. Patients classified by these health professionals as needing PT services over a given period and who reported receiving no PT at the end of that period were classified as having unmet need as evaluated by the orthopedic surgeon or physical therapist for that follow-up period. Multiple variable regression techniques were used to compare improvement in 5 measures of physical impairment and functional limitation between the met and unmet need groups over the periods of 3 to 6, 6 to 12, and 12 to 24 months: percentage of impairment in knee and ankle range of motion (ROM), reciprocal stair climbing pattern, gait deviations when walking, self-selected walking speed greater than 1.2 m/s (4 ft/s), and the mobility subscores of the FIM instrument.

RESULTS: Patients with unmet need for PT as assessed by a physical therapist were statistically significantly less likely to improve in all 5 of the selected domains of physical impairment and functional limitation than patients whose PT need was met. These results remained constant after adjustment for patient sociodemographic, personality, and social resources, as well as injury and treatment characteristics, reported pain intensity, and impairment level at the beginning of the study period. Patients with unmet need for PT as evaluated by an orthopedic surgeon were significantly worse off than patients with met need in only 1 of the 5 selected measures (ROM).

CONCLUSIONS: The results are consistent with a beneficial effect of PT after lower-extremity trauma. The results point to a need for improved standards for the prescription of PT services, and highlight the importance of involving a PT professional in the prescribing process.

I think the conclusion is relatively strong worded in regards to not just the importance of physical therapy intervention, but that outcomes were affected by whether the PT was involved in the decision making for rehabilitation. While it would be a stretch to generalize these conclusion to other lower extremity conditions seen in PT (elective post-op, sprains/strains, neuromuscular) it's important that MD's (the gate keepers in the health care world) begin to shift their view of PT's as less of an adjunct of THEIR treatment to micromanage, and instead begin allowing themselves to work with PT's as health care professionals that bring a different body of knowledge to help in the conservative treatment of neuromusculoskeletal conditions.

Jason L. Harris

Article Reference

Labels: Direct access, evidence based medicine, lower extremity, physical therapist

Osteoarthritis (OA) is no doubt a growing cause of loss of function in our society. MSNBC's Health department recently reported on this growing epidemic related to total joint replacements. They are worth a watch. The first video found here discusses the financial impact on Medicare and the second seems more of a marketing clip for total joint replacements. What caught my ear was in the second video the surgeons comments on why total joints. To paraphrase he states total joints are done when "conservative" treatments don't help. He lists conservative treatments as "medications and drugs..". Wow, is it any surprise that these failed? Not many of us can manage chronic progressive pain with medications.

What is disappointing is the utter lack of mention of what literature shows helps and what is a first line recommendation for pain and dysfunction related to OA. That is Physical Therapy. PT is less expensive, can lead to independence in pain management, has good long term outcomes, and has little to no potential negative effects. These qualities are almost completely opposite of what pills and injections offer.

I've seen total joint replacements completely change a persons function, but if we truly want to decrease costs of conservative management of joint pain, we need to shift away from expensive drugs and injections, eliminate unnecessary imaging, and encourage the return of individuals control over their physical well being.

So, you've got drugs, you've got surgery, or you've got Physical Therapy. Let's let individuals know about their choices.

Jason L. Harris

Labels: Direct access, Medicare, Osteoarthritis, physical therapy

Tallahassee, Florida, October 20, 2008 – Neck pain is one of the top 10 reasons for a patient to visit a doctor. The lead article in the most recent issue Spine reports on the results of a randomized clinical trial which demonstrated that patients who received manual physical therapy and exercise had twice the improvement in symptoms compared to the current guideline group. The subjects in the study experienced both short and long term improvements in their neck pain. The study compared the use of manual therapy and exercise compared to the current guidelines of advice, rest, and range of motion. The results of this study are comparable to those reported by Hoving et al in 2002, which also demonstrated that manual physical therapy and exercise resulted in excellent clinical results in the treatment of neck pain while also providing a significant cost savings compared to usual physician care (Kothals-de Bos et al 2003). Manual physical therapy includes the use of hands-on techniques including joint and soft-tissue mobilization, designed to restore motion and reduce pain. Hurwitz et al (2008) concluded in a systematic review on neck pain also in the journal Spine, “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain.”

Tim Flynn, PT, PhD, president of the American Academy of Orthopaedic Manual Physical Therapy, expressed confidence that, “This study broadens the base and depth of evidence that manual physical therapy is the first line treatment for patients suffering from neck and arm pain.” He continued, “Year after year the physical therapy profession continues to produce high quality randomized, controlled trials that demonstrate conclusively that our profession provides better outcomes for less money, while also being substantially safer than other medical interventions. Wake up America, to a new day without pain.” If you have neck or back pain or the aches and pains of musculoskeletal problems contact your local physical therapist today.

Jason L. Harris

Labels: AAOMPT, Direct access, evidence based medicine, manipulation, Mobilization

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LEXANDRIA, VA — The American Physical Therapy Association (APTA) is urging female athletes — particularly soccer players — to consider a new warm-up program to help lower their growing risk of anterior cruciate ligament (ACL) injuries. The announcement comes as APTA celebrates National Physical Therapy Month this October, an annual observance designed to educate the public about the important role physical therapists and physical therapist assistants play in the health care system.

Concurring with a new study published in the American Journal of Sports Medicine (August 2008), APTA says specialized stretching, strengthening, agility and jumping exercises could lower the overall ACL injury rate among female athletes.

The study evaluated outcomes of NCAA Division 1 female soccer players who performed the Prevent Injury, Enhance Performance (PEP) program, designed by physical therapists at Santa Monica (CA) Orthopedic and Sports Medicine Group. Those who performed the PEP program had an overall ACL injury rate 41 percent lower than a group of female athletes who did their regular warm-up. This was one of the largest studies conducted in the NCAA with 1,435 athletes participating.

The PEP program, one example of the many physical therapy-based programs that have demonstrated an equal ability to reduce ACL injuries among female athletes, consists of sport-specific agility exercises and addresses potential deficits in the strength and neuromuscular coordination of the stabilizing muscles around the knee joint. Physical therapist and APTA spokesperson Holly Silvers, MPT, who helped develop PEP, says, "The program was created to address the deficits that are seen in female athletes, particularly weakness in the lateral hip muscles, gluteal, and core muscles." These deficits can contribute to ACL injuries, notes Silvers.

According to physical therapist and APTA spokesperson Mark Paterno, PT, MS, MBA, SCS, ATC, coordinator of orthopedic and sports physical therapy at Cincinnati Children's Hospital Medical Center, recent research published in the British Journal of Sports Medicine found that ACL tears occur four times more frequently in females than in males involved in the same amount of sports participation. He says the difference in neuromuscular control, or the way our muscles contract and react, is one of four primary factors contributing to why women are more susceptible to knee injuries than men. Other discrepancies are anatomical (men and women are structurally differently), hormonal (women's hormonal makeup affects the integrity of the ligament, making it more lax), and bio-mechanical (the positions our knees get in during athletic activities).

Sample exercises athletes can perform to avoid ACL injuries can be found on the APTA Web site, www.apta.org/consumer.

"Women perform athletic tasks in a more upright position, putting added stress on parts of the knee such as the ACL, resulting in less controlled rotation of the joint," said Paterno. "While men use their hamstring muscles more often, women rely more on their quadriceps, which puts the knee at constant risk. To combat these natural tendencies, physical therapists may develop a treatment program to improve strength, flexibility, and coordination, as well as to counteract incorrect existing patterns of movement that may be damaging to joints," he added.

Silvers notes that physical therapist-designed programs can teach athletes how to avoid abnormal movement patterns and lessen stress on the knee, which may include exercises to strengthen hamstring and core muscles.

"Whether patients are athletes or not, physical therapist expertise includes not only rehabilitation and restoration of normal levels of function, but also education regarding how to prevent further injury," says Silvers.

Labels: APTA, Direct access, evidence based medicine, exercise

Google has released their online health information service. You can navigate to it by clicking here. While I fully support individuals taking positive steps in understanding and becoming a participant in their healthcare, I hope this service is just a step for the layman to organize their knowledge of their health and not a step turn over control of a patient record to the individual themselves.

The legal ramifications of how to practice when the individual has complete control of how and what is entered into their health record is frightening.

What is your opinion? Great step or bad road to go down?

Jason L. Harris

Labels: Direct access, google, Healthcare, Open Access

Labels: Direct access, evidence based medicine, Medicare, physical therapy

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

Labels: Direct access, EBM, education, evidence based medicine, Medicare

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

Labels: Direct access, education, LBP, Low back pain

I thought I would share some resources on how to find a Physical Therapist in your area. The yellow pages is an Ok place to start. Asking a friend or you primary care provider whom they'd recommend is another option. For those that can't or don't want to use these options, there are a few tools on the internet that will help you:

• Find a Physical Therapist - A search engine provided by the American Physical Therapy Association (APTA). It lists physical therapists via a specific radius from a given zip code. You can also filter by specialty (orthopaedics, geriatrics, etc). Limited as only members of the APTA are listed - but...would you want a PT that doesn't participate in their professional organization anyways?
• Find a Orthopaedic Manual Physical Therapist - The American Academy of Orthopaedic and Manual Physical Therapists (AAOMPT) provides a tool to find physical therapists that have advanced training, via a fellowship, in orthopeadic manual therapy. While all PT's use manual therapy in some form, these PT's have demonstrated advanced skill and knowledge with it's use.

Good luck with your search!

Jason L. Harris

Labels: Direct access, how to find, physical therapist, physical therapy, search

A subject that is, again, seeing some light in PT world is Physician Owned PT clinics or POPTS as they are often referred to (acronyms are cool). This subject is also being discussed over at Evidence In Motion and Rehabedge (a rehabilitation forum).

Why are these a problem or concern to those outside the PT profession? This is an excellent question, because this situation does affect the general public as well as my profession.

I'll forgoing making any claims of the ethical nature of a physician owned clinic or those PT's that work for them. Suffice to say, it IS bad policy. While the mantra of these setups is that it is an attempt to provide convenient care with better oversight, in the end it is more about improving the revenue stream than patient care. An MD wanting to make money is not a bad thing. But, POPTS do present specific problems:

1. Inherent conflict of interest. The MD stands to profit from referring a patient to the clinic THEY OWN.
2. Doing so restricts a patient's CHOICE in regards to PT consultation.
3. When a patient can be used as an additional revenue source, the trust between that patient and the doctor is seriously compromised.
   
4. POPTS directly impact the autonomy of an individually licensed, regulated, and recognized profession. Doing so can affect the quality of care a patient seeking consultation with a physical therapist receives.
   

Additionally, a well known study done by Jean M. Mitchell, PhD, published in the Journal of the American Medical Association (JAMA) found the folowing in regards to POPTS:

• “Visits per patient were 39% to 45% higher in joint venture facilities.
• “Both gross and net revenue per patient were 30% to 40% higher in facilities owned by referring physicians.
• “Percent operating income and percent markup were significantly higher in joint venture physical therapy and rehabilitation facilities.
• “Licensed physical therapists and licensed therapist assistants employed in non-joint venture facilities spend about 60% more time per visit treating physical therapy patients than licensed therapists and licensed therapist assistants working in joint venture facilities.
• “Joint ventures also generate more of their revenues from patients with well-paying insurance.”

For those being referred to a physical therapist, ask you MD if they have financial interest in where they are sending you (seems as though they should tell you upfront, doesn't it?). If you are not comfortable with this situation, request that they refer you to a more convienient or non-physician owned PT clinic. You can also go HERE to do a search for local physical therapists and how to contact them directly.

Jason L. Harris

Labels: AMA, APTA, Direct access, education, kickbacks, physical therapist, physical therapy, physicians, POPTS, referral-for-profit

Drugs, Surgery, or Physical Therapists

A great post over at Evidence in motion on good news coverage on the benefits of physical therapy. I usually don't like to make post on other posts, but this seems to scream to be an exception. Please click the link above to read.

Here is the link to the video on back pain and physical therapy.

Labels: Direct access, evidence based medicine, LBP, Low back pain, physical therapy

A committee formed by the Osteoarthritis Research Society International (OARSI) released a document on what they feel are evidence based recommendations for treatment of hip and knee Osteoarthritis (OA). The stated goal of this committee was:

To develop concise, patient-focussed, up to date, evidence-based, expert consensus recommendations for the management of hip and knee osteoarthritis (OA), which are adaptable and designed to assist physicians and allied health care professionals in general and specialist practise throughout the world.

A very noble goal indeed. What I'm excited about is that the committee did not include a single physiotherapist/physical therapist, yet our profession figures very prominently in most of the "non-pharmacological" treatment recommendations. The paper goes on to state, specifically, that referral to PT for symptomatic knee and hip OA was "strongly supported" and recommended by "100% of the experts" on the panel.

Good news for us. Now if we can get this into the hands of the public, all would be even better.

Jason L. Harris, PT

Labels: Direct access, evidence based medicine, Healthcare, OA, Osteoarthritis, physical therapy, special test

Arelease from the APTA states the NATA (athletic trainers association) has filed a lawsuit against them for "anticompetitive" activities. The main point relates to MANUAL THERAPY, specifically rib and spinal manipulation. Now, as the few of you that read my posts know, I'm a big believer you don't need 4 years of hot air and philosophy to manipulate the spine, but you do need to have an excellent background in systems review, examination skills, and a wide knowledge of differential diagnoses. Chiros have this and PT's have this, but I don't see this with ATC education. And I choose a "masters" level education, which is the "new and improved" ATC degree, to highlight this.

I make no claim that I could effectively manage the day to day sports injury needs of a sports team or walk the sidelines of a game and provide the triage care that an athletic trainer can. However, ATC's are beginning to push their limited rehabilitation education into the realm of PT, and I guess DC. This is just another example of people wanting more than they are willing to go to school and get the education for. Heck, internally we even exclude PTA's from MT courses because IT IS OUTSIDE OF THEIR educated abilities. Here is the statement from the APTA:

APTA Responds to NATA Lawsuit

The National Athletic Trainers' Association (NATA) on February 1, 2008, filed a lawsuit against APTA and the Orthopaedic Section, APTA, Inc. in the U.S. District Court in Dallas. The complaint alleges that the APTA and the Section have violated the antitrust laws by seeking to deny athletic trainers (ATCs) access to the market for manual therapy and by coercing physical therapists to refrain from educating ATCs in certain techniques. APTA's counsel is currently reviewing the complaint. APTA believes that the NATA lawsuit is wholly without merit.

Physical Therapy can ONLY be provided by lisenced PHYSICAL THERAPISTS. Not by ATC's who wish themselves physical therapists.

For more fun reading, here are some additional links:

• NATA's Letter to the APTA - laughable
• Addendum to the above letter
• APTA's letter to NATA
• NATA's Injunction Filing

What is sad, is that we NEED ATC's. They are an integral part in the healthcare field. However, they are not physical therapists and yet they not only want to act like PT's their informational pamphlets boast about how ATC can be abused for economic gains being used as PT's by physicians and hospitals:

The value of certified athletic trainers isn’t limited to the
sports field. While ATCs have worked with orthopedists and in
rehabilitation clinics for the past 40 years, they can provide
a great deal of assistance – and additional revenue – to a
hospital, physician office or clinic, whether it be a large,
university-run complex or a small, private practice.

Then from a "FACT SHEET":

1. FACT: All athletic trainers have a bachelor’s degree from an accredited college
or university. Athletic trainers are health care professionals similar to physical,
occupational, speech, language and other therapists.

Sure, and I have a Doctorate degree similar to medical doctors then. What? It's not? Somebody better tell the NATA then.

To me, it seems the NATA may be trying to convince the lay public that they are in fact physical therapists with out having to go to physical therapy school. I hope you don't make the mistake of taking your grandfather s/p CVA or your mother with a diabetic ulcer, or your uncle who is trying to recover from a heart attack to a professional with out the educational background to effectively, and possibly, safely treat them.

It one thing to wave the magic wand (ultrasound) over someone and educate them in therapeutic exercise (which I believe ATC's surely do well) it's another thing to claim to be on par with THE experts in neuromusculoskeletal evaluation and rehabilitation.

Labels: APTA, Direct access, EBM, Healthcare, NATA, woo

While I try to stear clear of blogging on the US vs. Them, PT vs. Chiro debate (although my look at the use of the DRX9000 seems to be viewed by chiros as an assault on them), the underhanded way that profession is trying to "claim" manipulation in my state has brought this post out of me.

I want to first comment on how the Chiro profession is handling itself in Nebraska in regards to the PT profession updating our practice act (which dated back to the 1960's IIRC). Their must be respected powerful lobby was threatening to hold up this new legislation because the new act included language about the use of mobilization and manipulation (these are one in the same to the PT profession). "Oh no you don't" the Chiros exclaimed. They pulled out the old very false but effective crap about no having the training or skill to do (hmm, what was that I was learning in PT school then???) High Velocity Low Amplitude (HVLA) manual therapy. And, like PT's always do, we repented and asked the Chiros what we need to do to fix it. "We'll compromise" they offer.

So manipulation was crossed out and "Grade V mobilization" was added (again, in PT, manipulation and mobilization are one in the same). So, the bill is passed (will hold off on the commentary about Orthos objections to the use of "Physical Therapy Diagnosis"; Orthos and Chiros objections to "direct access" even though we've always had it by omission and no one has died - GASP!; and the school systems wanting to bill the government for PT despite providing care with untrained aides). Fast forward a year, and as the new practice act proceeds through it's many steps to fruition - A practice act is just a guideline, and specific rules and regulations need then to be developed from it - Chiros are back shouting "hold on!". We changed our minds, we object to "Grad V mobilization" cuz we say you can't do it. So it's back to expending money, time, energy, and sweat to again fight for what we've already attained. So, the Chiros back off with a knowing smirk of "we'll be back again".

The second item that brought me to write this was a great post by Panda Bear, MD entitled "Stealth Medicine and Other Topics" railing on Chiro's attempt at backdooring into becoming pediatric primary care providers. As Panda Bear quotes them:

“The doctor of chiropractic does not treat conditions or diseases.” Says so right in their mission statement. But then a little further down it ascribes complaints in every system to our old friend the subluxation and promises, by judicious adjustment of the pediatric spine, to allow the body to express a better state of health and well-being.

Imagine that. Promising one thing and practicing the opposite. Sounds familiar to me. Orac at Respectful Insolence and Eric at Evidence In Motion have both commented on a visited this particular post (Damn, I am slow on the uptake I guess). I'll quote Eric as a nice summary to all of this:

For those non-physical therapists reading this, it may be timely to point out that what IS in our scope of practice is all sorts of manipulative therapy. That's right, the specialization area of Orthopaedic Manual Physical Therapy is one where the physical therapist is equipped with both the tools to manipulate the spine or peripheral joints AND develop a comprehensive, integrated program of neuromuscular modalities for orthopaedic conditions.

For an excellent comprehensive look at the history of PT vs Chiro, the arguments analysed and what is most likely behind Chiro's fighting PT's over manipulation (hint: it's not really patient safety. Ok Hint #2: It starts with "M" and ends in "oney") click here.

Labels: APTA, Direct access, DRX 9000, education, manipulation

Rising healthcare costs and the health insurance industries continuous push to maintain high profits have lead to higher and higher copays. Especially in PT where insurance companies aren't really sure what they are paying for. It's not uncommon for me to have patients come in with insurance benefits that require a $25-$35 copay per visit. Plus, there is usually some arbitrary visit limit to boot! Many patients balk at this, and our first reaction is to sympathize with them and help make excuses why they don't have to come in, or don't have to come in often. Is this the right approach, though?

A colleague and I just had a conversation today regarding this, and Larry Benz, coincidentally, posted his opinions related to copays over at Evidence in Motion. I won't cut and paste what he states, but I will express my take on the issue.

Do not make excuses for a patient's insurance copay. If you think it's too expensive, then did they really need to be in to see you in the first place? If they need your services, then don't be afraid to let them know and provide them with that service.

Another issue in the area I work in is the difference in copay for a PT owned outpatient clinic vs. a hospital run outpatient clinic. Basically, the PT owned copay is high and the hospital has none. What does one do in this situation? Refer to the hospital to "save" the patient money? If so, then what does that say about your business and your beliefs about your clinical skills when you confirm to this patient that the clinic choice doesn't matter, only the cost (so choose the cheapest?).

In the end, if you are providing quality, outcome oriented, evidence-based treatment, then you should let that prospective patient know that and then give them their moneys worth for treatment without letting that high copay rule over you.

Labels: Copays, Direct access, Healthcare, insurance, physical therapy

I
occasionally receive comments from readers. My post on the traction machine called the DRX 9000 is a good example of many different comments left. I have recently began receiving many "Anonymous" posts that attack me directly or are far off subject. Examples being "Anonymous" drawing up arms to have me prosecuted for libel and this most current unpublished one:

Why won't you post all comments?

That is what a blog is for?

You post "under investigation" about your competition, but you won't post factual occurrences about your own profession?

Why would this be?

Please post the recent submission about the "fraud" that has been going on within the Physical Therapy profession.

Must keep an educated and unbiased look at everything :)

Until then, this is just a biased blog toward your own advancements, that is all that it is.

My reply? If you don't have the balls to not post anonymously and do so to attack me or make comments not relative to the original blog post, I will unilaterally reject the comment. I have ok'd every opposing view that stayed on subject.

Oh, and yes, this blog is for my advancement and physical therapy in general advancement. I make no hidden agendas in that right.

Conclusion, stay on subject and I have no problem publishing your comments.

Labels: Chiropractic, Direct access, DRX 9000, physical therapy

Found a brief PR article on lumbar stabilization by Physical Therapists. It is from ADVANCE magazine and the article can be found here. It appears directed at nurse practitioners, which is an important audience for us as more and more of family practice is being handled by "second tier" providers.

Maybe something that could be added to you "packet" of general information one could provide to your referral base.

Labels: Direct access, education, Low back pain, physical therapy, physicians