MedWorm: Physical Therapists

Just make sure the patients aren't medicare

MyPhysicalTherapySpace.com — Fri, 16 May 2008 12:24:23 +0100

Or you will be in trouble! Great work University of Kentucky. larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

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Sacroiliac joint fusion and the implications for manual therapy diagnosis and treatment.

Physiospot - Musculoskeletal — Fri, 16 May 2008 04:00:00 +0100

Dar G, Khamis S, Peleg S, Masharawi Y, Steinberg N, Peled N, Latimer B, Hershkovitz I The present paper examines gender differences and changes in prevalence of ankylosed sacroiliac joint (SIJ) with age. SIJs of 287 patients, aged 22-93 years,... (Source: Physiospot - Musculoskeletal)

Sensorimotor disturbances in chronic neck pain--range of motion, peak velocity, smoothness of movement, and repositioning acuity.

Physiospot - Musculoskeletal — Fri, 16 May 2008 04:00:00 +0100

Sjölander P, Michaelson P, Jaric S, Djupsjöbacka M The purpose of this pilot study was to evaluate sensorimotor functions in patients with chronic neck pain with objective and quantitative methods. A group of 16 patients with chronic idiopathic neck pain... (Source: Physiospot - Musculoskeletal)

Aaompt annual conference 2008

MyPhysicalTherapySpace.com — Thu, 15 May 2008 19:27:17 +0100

AAOMPT Annual Conference October 29-November 2, 2008 Seattle, Washington Pain: From Science to Solutions On-line Registration and Program Information is Now Available! The 2008 AAOMPT Annual Conference is the national conference where persons having a common interest in orthopedic manual physical therapy (OMPT) may meet, confer and promote research, practice, and patient care. The conference programming will focus on the various types and causes of pain providing attendees with state of the art treatment strategies. Don’t miss this opportunity to participate in this important conference with your peers and gain information and resources to advance your skill level and increase proficiency in OMPT. Please forward this info to all of your PT colleagues who are not AAOMPT members. Let the secret out that the AAOMPT Annual Meeting is the most exciting and informative PT conference in the US! Make the decision to attend and register today!!! Click here for on-line registration! Exceptional Educational Opportunities will be offered. Pre-Conference Sessions. These sessions will offer in-depth information and interactive group dynamics to present best practices, tools and applicable solutions in four hot topic areas. Keynote Presentations: Manipulating the Brain by David Butler, Neuro Orthopaedic Institute Australasia Pty, Ltd., Treating Chronic Back Pain: Can There Be Too Much of A Good Thing? By Richard Deyo, MD, MPH, and How Does Manual Therapy Inhibit Pain? By Steven George, PT PhD Educational Breakout Sessions. A full day of educational breakout sessions will be offered in repeating time slots to allow you to attend as many as possible. Updated program information is now on-line! Click here for the conference agenda and detail on educational sessions. Inclusive Registration Fees Full Conference Registration fees include the Keynote Presentations, Breakout Sessions, Research Day, entrance to the Exhibit Hall and networking meal functions including two lunches, Welcome Reception, Poster Presentation Meet and Greet reception and the Friday evening Reception and Dance. Registration Packages are available to combine Pre-Conference Course Registration and Full Conference at a cost savings! (Source: MyPhysicalTherapySpace.com)

The team approach

Vancouver Sports Physio — Tue, 13 May 2008 22:30:00 +0100

When I was working the National ski team, one aspect that I enjoyed the most was the true team approach. Every single staff member, from coaches, doctors, technicians and media personnel worked together with myself to do what was best for the athlete. Every decision was based on this. Once I returned to clinic work after 3 years of this, I was disheartened with the lack of teamwork from the practitioners within the community. There are professionals out there who believe they have all the answers and disregard any other options. This is especially bothersome when they employ unsupported techniques and are not backed up by qualifications and experience (but that’s a whole other story). This approach is not worthy of an elite athlete and it’s not worthy of the average person. At my new practice, restoring this open interdisciplinary communication is one of our primary goals. We work together with the doctors within our practice, personal trainers, strength & conditioning coaches, select chiropractors, massage therapists and you. Regardless of who you see, ensure they are willing to communicate with other team members (doctors, coaches, etc...) and that they are well qualified to do what they claim to.In the next post I’ll be sure to include a list of practitioners from various fields that I support and work together with.Harry (Source: Vancouver Sports Physio)

I'm famous! (joke)

Vancouver Sports Physio — Tue, 13 May 2008 19:54:00 +0100

This is just some fun news, nothing important.Some of the pictures from our Envision Physiotherapy website, made it onto the cover of the new physio directory. I know my modelling career wouldn't have taken off, because, as you can see from the picture they used on the BC Physio website, my back is turned.Oh well, I guess I'll have to keep my day job. (Source: Vancouver Sports Physio)

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Girl power

MyPhysicalTherapySpace.com — Tue, 13 May 2008 14:50:06 +0100

A couple of truths: 1. The real health care decision making is made by women. 2. Women are way more apt to tell folks about the value of your service thru word of mouth marketing than men. 3. Women are much more likely to look up information about their healthcare than anybody else. 4. The typical PT patient is a slightly older soccer mom. 5. If you had to choose to provide the best in customer service to one patient, it had better be a woman. Per EVEolution “Women don’t buy brands, they join them”. So, why the fuss about women on the EIM blog? First, I believe that the value of outpatient PT will be told by women. They are key ambassadors for our profession and the better we understand the issues and their power in the market place, the better off we are as practicing PT’s. Secondly, because I am ticked! Most of my favorite bloggers are women-especially mommy bloggers and amongst my favorite is sk-rt.com who actively promotes my absolute favorite blogger-Jenny the Bloggess (if not in your readers, now is the time. Fair warning, her blog is way more risqué than our whore of the month club and 10x funnier than the EIM team could ever be). She also writes a cleaner column for Good Mom/Bad Mom that appears in the Houston Chronicle. If you noticed, I didn’t hyperlink sk-irt.com because some idiots at Morris Publishing have a supposed girl power magazine named skirt magazine and have forced sk-rt to change their name. In fact, they filed a lawsuit. It is well chronicled here and here. Skirt Magazine is hypocrisy at its best-kind of like ACN of United Health Group. So, don’t get Skirt Magazine but be an avid reader of sk-rt.com’s new name kirtsy.com. It will lighten your day and make you forget about the Insulated Idealists and their quest to ruin PT as a profession. Larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

Biochemical basis of the effect of chondroitin sulphate on osteoarthritis articular tissues

Physiospot - Musculoskeletal — Tue, 13 May 2008 04:00:00 +0100

J Monfort, J-P Pelletier, N Garcia-Giralt, J Martel-Pelletier Osteoarthritis is a chronic disease characterised by irreversible damage to joint structures, including loss of articular cartilage, osteophyte formation, alterations in the subchondral bone and synovial inflammation. Pain, functional disability and impairment... (Source: Physiospot - Musculoskeletal)

Open versus closed kinetic chain exercises for patellar chondromalacia.

Physiospot - Musculoskeletal — Tue, 13 May 2008 04:00:00 +0100

Bakhtiary AH, Fatemi E This study was designed to compare the effect of straight leg raise (SLR) and semi-squat exercises on the treatment of patellar chondromalacia. 32 participants with patellar chondromalacia were randomly assigned to either SLR or semi-squat exercise.... (Source: Physiospot - Musculoskeletal)

The most important issue in the pt profession.

MyPhysicalTherapySpace.com — Sat, 10 May 2008 14:43:49 +0100

And I really mean it. There is a raging debate within the PT profession. Over past several weeks, I have seen it as part of many discussions and it was recently manifested on a PT listserve of the administrative section of APTA. I know that listserves are “old technology” but it actually works well for PT’s who tend to be slow adapters and certainly if it isn’t broke, don’t fix it! The debate is centered over a seemingly growing movement that unfortunately has far reaching consequences: Do all services rendered within a PT clinic have to be one on one and performed by a PT or a PTA (I personally would prefer to leave the PTA out of any discussion but since medicare in much of their policy implementation makes us reimbursement equals, I will include). The debate unfolds something like this: The Players: Practical Practitioners: PT’s mostly who are in private practice or typically on a day to day have some encounter with the repercussions of the economics of their practice. If not in private practice, they oversee a department or a clinic and its financial performance and thus are faced with reimbursement realities, compliance, and trends and the pressure to keep their department or facility above water. Insulated Idealists: PT’s in the industry who don’t practice at all (e.g. some academics), or who make their living not in PT practice but in lecturing to PT’s on reimbursement or coding, most members of the federation of state boards, or PT’s who are in a niche industry (e.g. they do 100% cash Pilates) that is grossly atypical and misrepresentative of the overall PT sector. The bottom line on these idealists is that at the end of the day they never are faced with the real world difference between the service of PT and its financial viability. The Debate: According to the Insulated’s, 100% of all PT has to be done one on one by a PT or PTA without exception and to do anything to the contrary is fraud and should be punished by jail, fine, license revocation or preferably all three (truth be told a few canings ought to be in there as well). They believe that Medicare superimposed rules are the best thing since the Wii and that the CPT codes by definition further support their position and every attempt should be made to gather national payors to get their acts together and adopt medicare as the de facto standard and in addition open up every practice act in the US and amend those to be of the same standard and consistency in every state where their position is duly reflected. Iinsulateds believe that nothing should every be left to the judgment of a PT but rather every possible clinical scenario and intervention should be explicitly listed and reflect that it has to be done one on one PT or a PTA. They frequently site the excessive use of techs and aids in PT departments. For the PTA, they typically suggest that the PTA is duly licensed and essentially the equivalent in every way except for evaluation, manipulation, and debridement (some Insulateds would point out that an advanced PTA can perform the last two). Even a hot pack that nobody pays for has to be applied by a PT or PTA. In there world, nothing is left to chance and the list of rules for PT and practice acts would be about the same size as Tolstoy’s War and Peace. Economics is never considered because their fundamental belief is that PT ought to be free anyway and that any PT who makes more then them is a greedy crook who only looks at money. On the other side is the Practicals. They believe that medicare superimposed rules are stupid and that although you have to follow them that every attempt should be made to get rid of them and more importantly stop the madness from methastasizing to other payors. The Practicals believe that a PT’s education and practice act allow both delegation of care and supervision in accordance to their judgment as a PT. They believe appropriate checks and balances are in place to prevent the excesses and avoid the impulse to manage to the small percent of PT practices that abuse the rules. Practicals look at the CPT codes in the same manner that physician’s-unless explicitly stated, supervision of support personnel thru delegation and direction aptly meets the description of the code even in cases where the word “one on one” is used as long as the one on one by a support person is done under supervision as outlined in their state’s practice act. Relative to Vision 2020 Practicals actually buy into it and see the attempt by Insulateds as de-evolutionary to the profession. Practical believe that the Idealist’s view of Vision 2020 is illusionary. They believe Insulateds don’t see how their position runs contrary to a direct access practitioner who is autonomous Practicals take the position that a doctorate degree with advanced clinical training is best positioned to make judgments within the scope of practice of what their support personnel can do in much the same way that you see physicians manage their nurses and techs. Practicals both laugh and are incensed by the Insulated’s activism toward amending practice act and attempts to make all care explicit. A practical would ask “do you see physicians trying to eliminate their nurses and support personnel from their supervision?”. Practicals are faced with the financials repercussions of not taking certain contracts or the difficulty of trying to align quality care in a declining reimbursement arena by applying appropriate resources in conjunction with the insurance that patients have. Practicals site the great success of the military and VA system who have empirically shown their cost effectiveness in an environment where reimbursement is not an issue and where the PT is given significant autonomy and unfettered supervision over their techs and support (and at least the case in the military prescriptive authority and ability to refer for imaging). Practicals would like to debate eliminating PTA’s from the profession and site the drastic educational differences and the inconsistent Medicare policy towards them. Any attempt to align a PTA as equivalent to a PT is appalling to a Practical. Practicals also site that evidence does not exist to support any of the condescending positions taken by the Idealists and that the free market thru both quality indicators and consumerism will determine the most efficacious delivery of PT. Practicals believe that PT can be economically viable if the shackles of the regulatory environment were lifted and the idealists would halt their ways in attempting to further restrict the profession from becoming autonomous providers. Practicals believe that without margin their is no mission and that without economic viability that our best and brightest will not seek out a PT career and that we will quickly head towards a 7 year degree getting $27 per visit for one on one care with more loan debts than a third world country. I don’t think you have to guess which side that I am on. The Question: Which side are you on? Who is winning? What are the implications of Insulated’s position for the future of PT? larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

Differences in standing and forward bending in women with chronic low back or pelvic girdle pain: indications for physical compensation strategies.

Physiospot - Musculoskeletal — Sat, 10 May 2008 04:00:00 +0100

van Wingerden, Jan-Paul; Vleeming, Andry; Ronchetti, Inge The objective of this study was to determine whether subcategories of back pain patients could be distinguished by motion characteristics of the pelvis and lumbar spine. It compares motion characteristics during forward bending... (Source: Physiospot - Musculoskeletal)

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Exercise for fibromyalgia: a systematic review.

Physiospot - Musculoskeletal — Sat, 10 May 2008 04:00:00 +0100

Busch AJ, Schachter CL, Overend TJ, Peloso PM, Barber KA This study evaluated the effects of exercise training on global well-being, selected signs and symptoms, and physical function in individuals with fibromyalgia (FM). Metaanalysis of 6 studies provided moderate-quality evidence... (Source: Physiospot - Musculoskeletal)

Intra- and interexaminer reliability of four manual shoulder maneuvers used to identify subacromial pain

Physiospot - Musculoskeletal — Fri, 09 May 2008 04:00:00 +0100

Kajsa Johansson and Sören Ivarson The objective of the study was to assess intra- and interexaminer reliability for four manual shoulder maneuvers; the Neer impingement sign, the Hawkins–Kennedy impingement test, the Patte maneuver, the Jobe supraspinatus test. The four standardised... (Source: Physiospot - Musculoskeletal)

Outcome following a physiotherapist-led intervention for chronic low back pain: the important role of cognitive processes

Physiospot - Musculoskeletal — Fri, 09 May 2008 04:00:00 +0100

Steve R. Woby, Neil K. Roach, Martin Urmston and Paul J. Watson The objective of this study was to examine whether patients with chronic low back pain exhibit changes in cognitive factors following Interactive Behavioural Modification Therapy (IBMT), delivered by... (Source: Physiospot - Musculoskeletal)

Reduction of experimental muscle pain by passive physiological movements

Physiospot - Musculoskeletal — Fri, 09 May 2008 04:00:00 +0100

Michael Møller Nielsen, Anne Mortensen, Jakob Kierstein Sørensen, Ole Simonsen and Thomas Graven-Nielsen The purpose of this study was to examine the effect of passive physiological movements (PPMs) on deep-tissue pain sensitivity. Seventeen healthy subjects participated in one session where... (Source: Physiospot - Musculoskeletal)

Influence of elbow flexion angle on mobilization of the proximal radio-ulnar joint: a motion analysis using cadaver specimens

Physiospot - Musculoskeletal — Fri, 09 May 2008 04:00:00 +0100

Sadanori Ohshiro, Egi Hidaka, Shigenori Miyamoto, Mitsuhiro Aoki, Toshihiko Yamashita and Haruyuki Tatsumi The purpose of this study was to determine the most effective elbow joint flexion angle for mobilization of the proximal radio-ulnar joint. Five fresh-frozen cadaveric elbows were... (Source: Physiospot - Musculoskeletal)

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Individual patient education for low back pain.

Physiospot - Musculoskeletal — Fri, 09 May 2008 04:00:00 +0100

A Engers, P Jellema, M Wensing, DAWM van der Windt, R Grol, MW van Tulder This is a systematic review from the Cochrane Library looking at the effect of individual information on non specific lower back pain. The review aims... (Source: Physiospot - Musculoskeletal)

Rush towards virtual practice

MyPhysicalTherapySpace.com — Wed, 07 May 2008 23:08:33 +0100

Rush Presbyterian in Chicago has been refining a Virtual Integrated Practice (VIP) for the past four years. The project has had multiple goals with the major goals noted as: Refining the VIP intervention and implementing it over an 18 month period in four practice sites focusing on patients with diabetes type II, chronic obstructive pulmonary disease and urinary incontinence. Evaluate the efficacy of the intervention with regard to consistency, costs, patient and provider perception, selected patient indicators of health status and changes in disease specific health parameters. Promote practitioner usage of VIP locally and nationally and distribute findings of VIP intervention through a variety of collaborative activities. Interestingly, the VIP team consisted of a nurse, a social worker/case manager, a physician, a pharmacist and a physical therapist. Note that in a very recent meeting with the reimbursement experts with APTA, there was quite a bit of buzz about new CPT codes for telemedicine and internet consultation..... Before you start ranting about the importance of seeing the patient in person and not trying to deliver care over the internet (please don't make me PT Whore of the Month!), I am curious if the group sees any use for this type of collaboration in the treatment of conditions like low back pain? I see great potential for this type of system in enhancing the communication and thus the access to the services of qualified PT's in a timely fashion. If we can get the low back pain patient in front of us quicker we should be able to have better results in many cases? This type of communication system also might allow for "pinging" the patient at defined intervals (3 months, 6 months....) to provide additional value (and gather additional data) to the patient over a longer period of time. What do you think? (Source: MyPhysicalTherapySpace.com)

Pt whore of the month club #4

MyPhysicalTherapySpace.com — Sun, 04 May 2008 21:54:36 +0100

As we catch up with our PT "Whore of the Month" Club award winners, we have named the April 2008 winner below. Before we do that, I will call attention to the ongoing debate about the name of the award itself, which continues to receive much scrutiny (which we welcome) as you can see from the comments posted to the March 2008 winner. We are still not convinced that the name should be changed but appreciate that the name is not endorsed by 100% of our readers. Btw, in response to some of the comments, we have issue whatsoever in naming a female for this award since definition #4 below applies. The fact that only males have previously won is pure coincidence and no indication of reverse discrimination whatsoever. Please send along some deserving female candidates and we'd be glad to include them to the list. Without further adue, the April 2008 winner of the PT "Whore of the Month" Club is...drumroll please... All chiropractors who think they can do "physical therapy" As you can see from websites like this, many chiropractors have been deluded into thinking they can provide "physical therapy", as if physical therapy was constituted in its essence by a "grab bag" of treatments, as opposed to itself a profession with professional boundaries such as licensure. Of course, states like Maryland (and the physical therapist whores who perpetuate this idea) whose chiropractic practice acts permit such a masquerade are acting whorish themselves. The good news for physical therapists is that there are all sorts of reasons not to become a chiropractor, not the least of which is that chiropractic was recently named to US News and World Report's "Most Overrated Profession" list. All in all there are far more reasons to feel sorry for the chiropractic profession than feel threatened. Check out this video from Dr. Bill Kinsinger if you'd like a succinct overview of some of the major problems in chiropractic. It's well worth your watch. Keep sending in your ideas via email at info@evidenceinmotion.com or feel free to post as comments! The EIM Team Previous PT Whore of the Month Winners: Jan 2008 - WebPT - PT Whore of the Month Club #1 Feb 2008 - Paul Duxbury - PT Whore of the Month Club #2 Mar 2008 - Alan Tyson - PT Whore of the Month Club #3 Disclaimer: In the event that anyone is concerned with our use of the word "Whore", we are referring to definition #4 below. whore- 1. a woman who engages in promiscuous sexual intercourse, usually for money; prostitute; harlot; strumpet. 2. to act as a whore. 3. to consort with whores. –verb (used with object) 4. Obsolete. to make a whore of; corrupt; debauch. (Source: MyPhysicalTherapySpace.com)

Ain't gonna ruin my derby week

MyPhysicalTherapySpace.com — Wed, 30 Apr 2008 14:33:06 +0100

At first, I thought it was the greatest May fool’s joke that I have ever seen, even though May 1st isn’t till tomorrow (In feat of symbolism this is how we celebrate it in KY-one month behind everybody else). Of course I am talking about the front cover of the PT Magazine of Phys (can’t tell what else it says as some kid who is playing the wii’s head is covering the rest of the magazine title). This is the glossy mag that accompanies our official Journal-Physical Therapy. It has been posted many times here, here, here, and here about what I will now refer as “the Paris Hilton of Physical Therapy” (you know something that continues to obnoxiously show up all the time and just when you thought it was gone shows up again)-otherwise known as the Wii as in Wiihabiliation (or Wii’s gone Wild). But, to see Paris Hilton of PT show up on a magazine produced by our professional association shows just how lost we are in any type of unified branding message. I am sure that the conversation went something like this: PT Magazine Idea Generator: “Why don’t we run our cover story on minority diversification, women’s health, or PT cash practices?” Colleague of Idea Generator: “Uhh, because we run that cyle every quarter?” Idea Generator: “No, I mean something really different this time! Let’s run them all three together! It will be the biggest issue of all time and amass record sales.”. Colleague of Idea Generator: “Uhh, well, the magazine is free so sales won’t matter but I am sure your idea will make or advertisers and their mother’s proud-let’s go with it”. Idea Generator: “Great! Wait! I really got it-let’s throw in a Wii into the picture!” I am quite confident that is how we got this month’s cover. We hit the trifecta again (pardon the horse pun). Just a few questions: is this ther ex or group? Does it matter if the kid is on medicare? Do you have to have a DPT or a tDPT to play (I mean facilitate one one one)? Most interesting thing to the whole debacle? Right below is “Also inside:“ with the first bullet point being about 21st Century Marketing for PTs. Hope the Idea Generator reads it for next month. But, it ain’t gonna ruin my Derby Week! larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

The influence of expectation on spinal manipulation induced hypoalgesia: an experimental study in normal subjects.

Physiospot - Musculoskeletal — Wed, 30 Apr 2008 04:00:00 +0100

Bialosky JE, Bishop MD, Robinson ME, Barabas JA, George SZ The purpose of this study was to determine the effect of subject expectation on hypoalgesia associated with SMT. Sixty healthy subjects agreed to participate and underwent quantitative sensory testing (QST)... (Source: Physiospot - Musculoskeletal)

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What pt looks like without medicare and regulations?

MyPhysicalTherapySpace.com — Mon, 28 Apr 2008 10:51:58 +0100

At Least We are #5 on Somebody's list. From the Tehran Times, Iran’s leading International Daily in an article entitled: Need a less stressful career? Here are eight secrets to work 5. Physical therapy assistant Whether giving and receiving backrubs at a massage therapy school, or practicing flexibility techniques in a physical therapy assisting program, you can learn how to help people maximize relaxation. And if you incorporate some of these exercises into your own daily routine, you could have a recipe for a tension-free workday. My favorite- help “people maximize relaxation”. I wish I could make this stuff up. larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

Disability in patients with chronic patellofemoral pain syndrome: a randomised controlled trial of vmo selective training versus general quadriceps strengthening

Physiospot - Musculoskeletal — Sun, 27 Apr 2008 04:00:00 +0100

G. Syme, P. Rowe, D. Martin and G. Daly This study compared the effects of rehabilitation with emphasis on retraining the vastus medialis (VMO) component of the quadriceps femoris muscle and rehabilitation with emphasis on general strengthening of the quadriceps... (Source: Physiospot - Musculoskeletal)

Glucosamine/chondroitin combined with exercise for the treatment of knee osteoarthritis: a preliminary study.

Physiospot - Musculoskeletal — Sun, 27 Apr 2008 04:00:00 +0100

S.P.Messier, S. Mihalko, R.F. Loeser, C. Legault, J. Jolla, J. Pfruender, B. Prosser, A. Adrian and J.D. Williamson This study sought to determine whether using 1500/1200mg of glucosamine hydrochloride and chondroitin sulfate (GH/CS) is effective, both separately and combined with... (Source: Physiospot - Musculoskeletal)

Reducing joint loading in medial knee osteoarthritis: shoes and canes

Physiospot - Musculoskeletal — Sun, 27 Apr 2008 04:00:00 +0100

Georgina Kemp, Kay M. Crossley, Tim V. Wrigley, Ben R. Metcalf, Rana S. Hinman This study evaluated the effects of shoes and a cane on knee load in people with knee OA. Forty people with medial knee OA underwent 3-dimensional... (Source: Physiospot - Musculoskeletal)

Progressive resistance training in patients with shoulder impingement syndrome: a randomized controlled trial

Physiospot - Musculoskeletal — Sun, 27 Apr 2008 04:00:00 +0100

Império Lombardi Jr., Ângela Guarnieri Magri, Anna Maria Fleury, Antonio Carlos Da Silva, Jamil Natour The purpose of this study was to assess pain, function, quality of life, and muscle strength in patients with shoulder impingement syndrome who participated in... (Source: Physiospot - Musculoskeletal)

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Looking for a brand - nice job ahrq!

MyPhysicalTherapySpace.com — Sat, 26 Apr 2008 20:31:59 +0100

Check out the new PSAs from the US Dept. of Health and Human Services' Agency for Healthcare and Research and Quality (AHRQ), and the Ad Council. The tag line: "Real Men Wear Gowns" is catchy. The website link from the ads states: "Whether it’s time for you to get a blood test or that test,you’re not just doing it for yourself. You’re doing it for your family and loved ones, because Real Men Know the Facts: One in 5 American men has heart disease. One in 3 American adults has high blood pressure. Three in 4 American men are overweight. Nine in 10 lung cancer deaths are caused by cigarette smoking. The single most important way you can take care of yourself and those you love is to actively take part in your healthcare. Educate yourself on health care and participate in decisions with your doctor—even if it means wearing an examination gown. This site will help you get started" This ad campaign was explained at PRWeek: Objective: The effort aims to make men more savvy healthcare consumers and get them into the doctor's office more often. The most recently released AHRQ Medical Expenditure Panel Survey (2005) found that men are 25% less likely than women to have yearly checkups. According to Ellyn Fisher, Ad Council director of corporate communications, "It's all about starting a dialogue." The key demographic targeted is US men over 40. "We went out and talked to men," she added, "and found in our conversations and focus groups that the reason [they] weren't going is they think they can handle things on their own." Idea: The campaign centers on PSAs and strategic media relations, which use a humorous tone while encouraging men to seek out doctors. Examples include a man in a doctor's gown walking his daughter down the aisle. Al Lazar, director of AHRQ's Office of Communication and Knowledge Transfer, emphasized that the communications team sought to maintain a positive focus by attaching the campaign to upbeat promotions, such as Father's Day and National Men's Health Week. Tools: In addition to the PSAs, the AHRQ launched a new Web site, www.ahrq.gov/realmen/quiz.htm, which provides preventative testing tips, referrals, a quiz, and videos. Former NBA star Sam Perkins will headline an SMT with the groups' leaders. The effort is also reaching out to bloggers and social media. Internally, PR materials were provided to AHRQ staff, partners, and constituents. Measurement: The team is monitoring the number and quality of titles that cover it, as well as Web site hits. Organizers believe the effort had already reached more than 5.3 million people in the first few days through its SMT, b-roll distribution, and other coverage. Company: US Dept. of Health and Human Services' Agency for Healthcare and Research and Quality (AHRQ), and the Ad Council Campaign: Real Men Wear Gowns PR Team: Internal teams Launch: April 21 Budget: About $100,000 (PR) From the April 28, 2008 Issue of PRWeek APTA - Are you paying attention?? (Source: MyPhysicalTherapySpace.com)

Acn/united want the tricare contract

MyPhysicalTherapySpace.com — Sat, 26 Apr 2008 13:14:30 +0100

I received the following message on a PT listserve: I received a letter from ACN/UNITED stating they are bidding for management of TRICARE. If you think it's a good idea to let TRICARE know of your experiences with the American Chiropractic Network (ACN) and UNITED, write a real quick letter of recommendation, or lack thereof, to the TRICARE address below. Action must be taken now as the contract is awarded "mid 2007." No one will act for you. TRICARE MANAGEMENT ACTIVITYSKYLINE 5SUITE 8105111 LEESBURG PIKEFALLS CHURCH, VA 22041-3206 I must commend ACN/United on their moxie to send a letter to PT providers. They are perhaps the most universally hated insurance company by PT providers in the US. Personally, while I think ACN represents a well intended and conceptually on track approach to physical therapy via provider profiling, tiering, outcomes, etc. their execution is a complete disaster. This is mostly due to their “parent” UHC having the final say in the ever important “reimbursement” part of the equation with areas of the US getting a $45 per visit take it or leave it approach. Therefore, ACN is really United’s attempt to be a provider “feel good” department and is the epitome of hypocrisy. That’s just my thoughts-what’s yours? Don’t forget to let Tricare know them as well. Larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

What the week meant to renee...

Physical Therapy Missions Blog — Thu, 24 Apr 2008 20:15:56 +0100

When we arrived in Guatemala and looked around we began to get a feel for the extreme poverty that many people lived in. It was hard to imagine how 11 people and 20 tubs of supplies in 5 days could really make a difference. However one day while we were treating, a little girl came in with butterfly AFO’s. The therapists told us that those AFOs had been brought down by last year’s team. Later in the week when treating a child with severe RA, we were discussing with the therapists the importance of working on his respiration and they brought out bubbles that were also brought by the team last year. I realized that we will never know the full impact of our trip and that it will have an effect long after we have gone home. The cultures of scarcity and plenty were brought home to us when the therapist showed us a piece of IV tubing that they were using as a therapy tool. She said “To you this is just trash. You just throw it away. But for us-we use it for therapy”. They are incredibly resourceful therapists with the little that they have and show great compassion for the children they care for. Throughout the trip I realized that there are many things that transcend language and cultural differences such as a smile, the joy of holding a child, basketball, candy, a desire to help, dancing (both on and off the table), laughter, and most importantly God’s love. (Source: Physical Therapy Missions Blog)

One way

MyPhysicalTherapySpace.com — Thu, 24 Apr 2008 13:33:56 +0100

To buck the trend toward insurance companies decreasing reimbursement. How did this clown end up with 4 clinics? larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

Pt whore of the month club #3

MyPhysicalTherapySpace.com — Tue, 22 Apr 2008 21:43:12 +0100

The PT "Whore of the Month" Club continues to be received with great fanfare, despite some strong objections to the label we have put on what has turned out to be a very popular feature. In light of our very transparent disclaimer below regarding which definition of "Whore" we are intending, we have elected to stay with the current title. Feel free to continue hammering us in your comments if you disagree, but plain language works well here and frankly the definition could not be more apropos. We were delinquent in publishing a March winner so will be catching up in the coming weeks. The belated March 2008 winner of the PT Whore of the Month Club is...drumroll please... Alan Tyson, PT, SCS, ATC-L, CSCS Mr. Tyson teaches a course through CIAO seminars titled "A Business Model to a Better Private Practice." CIAO's course description boasts that the course will teach us how to increase the number of referrals to our clinic and ways to compete against physician-owned practices. Mr. Tyson's philosophy is that practice representatives should position themselves as experts on a subject by providing several pieces of new educational information that are valuable and practical to either a potential client or referring physician. Because the therapist has positioned him/herself as an expert in the eyes of the intended audience, the potential client or physician will seek out that therapist when PT treatment is needed at a later time. This philosophy is fine and appropriate to teach during the course; however, Mr. Tyson apparently spends much of the time positioning himself as an expert on dietary supplements with the hope that participants will stay after the course and listen to his business model about how you can peddle his products in your clinic. And what do you learn about competing against physician-owned practices? Nada. There is actually no mentioning of it during his entire presentation. Although it is difficult to tell, it appears he may actually be employed in a physician-owned practice himself. Even if he somehow runs an independent PT practice on their behalf, peddling supplements alone is sufficient to make him worthy of the award. So, save your $275 or spend it on your loved ones lest you be scammed out of a previous Saturday of weekend leisure. Keep sending in your ideas via email at info@evidenceinmotion.com or feel free to post as comments! The EIM Team Previous PT Whore of the Month Winners: Jan 2008 - WebPT - PT Whore of the Month Club #1 Feb 2008 - Paul Duxbury - PT Whore of the Month Club #2 Disclaimer: In the event that anyone is concerned with our use of the word "Whore", we are referring to definition #4 below. whore- 1. a woman who engages in promiscuous sexual intercourse, usually for money; prostitute; harlot; strumpet. 2. to act as a whore. 3. to consort with whores. –verb (used with object) 4. Obsolete. to make a whore of; corrupt; debauch. (Source: MyPhysicalTherapySpace.com)

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Wii are human movement specialists?

MyPhysicalTherapySpace.com — Mon, 21 Apr 2008 15:18:20 +0100

As many of you are aware, the APTA has recently undertaken a strategic planning effort, which we have previously blogged about here (and are big proponents of its getting done). However, there is some early feedback about intentions to brand PTs as practitioners of choice for "human movement disorders" rather than using plain language that consumers and payers will actually understand. Think about it. Go ask 20 of your neighbors what a "human movement disorder" is and if they've ever had one. It's rather silly actually. I don't want to be too critical until we see the final version of the strategic plan, but I will confess to getting that sickening feeling again that we're about to cave to a vocal minority so that we can be all things to all people and not offend anyone with the use of practitioners of choice for “musculoskeletal conditions” terminology (neuromusculoskeletal works well too)…never mind that’s a phrase that resonates wildly with consumers and payers. If we are correct that "human movement" is about to be the centerpiece of our brand (I am hoping for a bad dream), only PTs can stare an epidemic of musculoskeletal conditions like LBP in the face (LBP accounts for 2% of all physician office visits…only routine examinations, hypertension, and diabetes result in more office visits) and try to carve out a new nebulous term that says our problem is actually human movement disorders. What is the ICD-9 code? Does it lead to sexual dysfunction? All the while, the cost of managing LBP increased 65% (adjusted for inflation) to $6096 in 2005 compared to $4695 per case in 1997, outpacing every other rate of increase in health care. Yet our problem is "human movement"? A marketing campaign around "human movement" will be difficult at best. We need Branding 101 to get enacted here quickly (Felicity, have you started yet?...we need you to save us from ourselves!). "Human movement" is analogous to watching the typical business owner market to themselves...mostly clueless about the customer and what our brand needs to mean to the customer. Unless we come to our senses, here are some possible brand tag lines for our "human movement" campaign. 1) Wii Are Human Movement2) Got Human Movement?3) PT: For When Your Movements Are No Longer Human4) Absolutely, Positively, Human Movement5) PT: The Missing Link in the Human Movement We will also need to revise our top diagnoses as seen by APTA to the following:1) Blackberry Thumb2) Back Pack Pain3) Human Movement Disorder For all three, the preferred treatment is Wii Therapy. Ok, enough ranting here, and we welcome anyone from APTA to suggest we're way off base (and pray dearly that we've got this one completely wrong). Regardless, we have to get the economics right on this one. At the current rate of decline in reimbursement, and considering the 5% per year decrease projected for Medicare, by the year 2020, we will be an organization of volunteer "human movement specialists" who are asked to pay dues for the privilege of working for free....what a deal! What we need is a major marketing campaign that targets real direct access for real conditions with which payers and consumers identify, LBP being the biggest one. We can only hope that common sense will prevail. Just an initial reaction. Your thoughts? The EIM Team (Source: MyPhysicalTherapySpace.com)

Effects of patellar taping on knee joint proprioception in patients with patellofemoral pain syndrome

Physiospot - Musculoskeletal — Mon, 21 Apr 2008 04:00:00 +0100

Michael J.Callaghan, James Selfe, Alec McHenry and Jacqueline A. Oldham The aim of this study was to assess the effect of patellar taping of the proprioceptive status of patients with patellofemoral pain syndrome (PFPS). 32 subjects with PFPS were tested... (Source: Physiospot - Musculoskeletal)

Do ‘sliders’ slide and ‘tensioners’ tension? an analysis of neurodynamic techniques and considerations regarding their application

Physiospot - Musculoskeletal — Mon, 21 Apr 2008 04:00:00 +0100

Michel W.Coppieters and David S. Butler The aim of this cadaveric biomechanical study was to measure longitudinal excursion and strain in the median and ulnar nerve at the wrist and proximal to the elbow during different types of nerve gliding... (Source: Physiospot - Musculoskeletal)

Role of the vastus medialis obliquus in repositioning the patella

Physiospot - Musculoskeletal — Sat, 19 Apr 2008 04:00:00 +0100

Lin, Y.-F., Lin, J.-J., Jan, M.-H., Wei, T.-C., Shih, H.-Y., Cheng, C.-K. The purpose of this study was to analyse if the morphologic characteristics of the vastus medialis obliquus correlate to patellar malalignment in patients with patellofemoral pain syndrome. In... (Source: Physiospot - Musculoskeletal)

Effect of home exercise of quadriceps on knee osteoarthritis compared with nonsteroidal antiinflammatory drugs: a randomized controlled trial.

Physiospot - Musculoskeletal — Sat, 19 Apr 2008 04:00:00 +0100

Doi, Tokuhide MD; Akai, Masami MD, PhD; Fujino, Keiji MD, PhD; Iwaya, Tsutomu MD, PhD; Kurosawa, Hisashi MD, PhD; Hayashi, Kunihiko PhD; Marui, Eiji PhD The objective of this study was to examine the effect of home-based exercise on knee... (Source: Physiospot - Musculoskeletal)

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Cost-effectiveness evaluation of an rct in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy.

Physiospot - Musculoskeletal — Sat, 19 Apr 2008 04:00:00 +0100

Søgaard R, Bünger CE, Laurberg I, Christensen FB The objective of this study was to conduct an evaluation to investigate the cost-effectiveness of (1) a low-cost rehabilitation regimen with a behavioural element and (2) a regimen of individual exercise therapy,... (Source: Physiospot - Musculoskeletal)

More fuel for the primary care physician fire

MyPhysicalTherapySpace.com — Thu, 17 Apr 2008 16:03:02 +0100

For those of you following, I have had multiple posts here, here, and here regarding an initiative that I think we need to get aggressive on-branding with primary care physicians for musculoskeletal exam and treatment. This is due in large part to the shortage of primary care docs that will be around for awhile as well as the transition of our own profession to direct access and autonomous providers. Others, namely nurses are aggressively pushing this extender position and we need to put ourselves in a similar position. This blog post appropriately titled, The End of the Primary Care Physician further adds fuel to this fire. It references and links several op-ed pieces including 2 WSJ pieces including one on Dr. Nurses) and a JAMA commentary. We need mass promotion of our transition to doctorate and our expertise in musculoskeletal medicine. We need to be leaders in helping Primary Care Medicine new definition. This fits well into the medical home model as well. thoughts? Larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

Attention physical therapists- speak truth to power

MyPhysicalTherapySpace.com — Thu, 17 Apr 2008 03:32:01 +0100

I was hoping to sit down to a glass of wine and relax tonight...but the recent issue of JAMA has raised my blood pressure and reversed the positive health effects of moderate alcohol intake. I encourage all members of the MyPhysicalTherapySpace community to read the 2 recent papers on the continuing saga of Merck, Vioxx, and a pharmaceutical industry that continues to place profits over patients. The first paper describes the disturbing fact that of a number of clinical trial manuscripts related to rofecoxib (Vioxx) were authored by Merck employees but often the first authorship was attributed to academically affiliated investigators who did not disclose industry financial support. It was even more rampant when it came to review manuscripts which the industry employees would write and subsequently attributed authorship to the academically affiliated investigators who would just happen to forget to disclose industry financial support (go figure). The second paper is more alarming in that Merck as early as April 2001, had clearly identified an increased risk of mortality associated with rofecoxib among patients in the Alzheimer disease trials, yet they faild to submit these disturbing findings to the FDA until 2003. As physical therapists we must continue to speak truth to our patients. We should distrust pharmaceutical interventions of chronic musculoskeletal conditions. Tim (Source: MyPhysicalTherapySpace.com)

Evidence for high resistance and low resistance

MyPhysicalTherapySpace.com — Wed, 16 Apr 2008 22:12:10 +0100

Most of you probably contemplate new evidence as it becomes published. What factors do you consider relevant if you determine to implement the evidence? The recent research comparing high resistance and low resistance exercise intensity for patients with knee osteoarthritis has me reflecting on how this could be implemented while considering all the stakeholders. It's great to know that exercise resistance at 80% of 1 repetition maximum (performing 3 sets of 8 repetitions) OR at 10% of 1 repetition maximum (performing 10 sets of 15 repetitions) both have favorable outcomes. On the surface it appears to be a win/win situation when making a clinical decision (effectiveness and evidence supporting the decision), but is it a win/win situation? In analyzing the win/win, other factors may be relevant in making a decision. The high resistance exercise intensity requires 30 minute sessions with a patient with knee osteoarthritis to acquire the reported results. The low resistance exercise intensity requires 50 minute sessions to acquire the reported results. Location of provision of services may clinically determine which option is more realistic to provide. Does the physical therapy cap apply for the practice setting? Does the patient have a high copay based on percentage of allowable? Does the patient have a preference? Selena (Source: MyPhysicalTherapySpace.com)

Quotes of the year

MyPhysicalTherapySpace.com — Tue, 15 Apr 2008 21:19:58 +0100

By crime novelist and professor of pediatrics and psychology at USC Dr. Jonathan Kellerman who wrote an opinion piece for WSJ. The health insurance model is closest to the parasitic relationship imposed by the Mafia and the like. Insurance companies provide nothing other than an ambiguous, shifty notion of “protection.” But even the Mafia doesn’t stick its nose into the process; once the monthly skim is set, Don Whoever stays out of the picture, but for occasional “cost of doing business” increases. When insurance companies insinuate themselves into the system, their first step is figuring out how to increase the skim by harming the people they are allegedly protecting through reduced service and what does he advise: Physicians and other providers need to liberate themselves from the Faustian bargain they've cut with the Mephistophelian suits who now run their professional lives. Because many doctors are loath to talk about money, they allowed themselves to perpetuate the fantasy that "insurance is paying." It isn't. There is no free lunch and no free physical exam. Fantastic! larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

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Maine physical therapists allowed to proceed

MyPhysicalTherapySpace.com — Tue, 15 Apr 2008 10:56:11 +0100

Recently a judge gave the nod for a class action suit. Christy Stout, PT and all licensed physical therapists in Maine who were participating providers with Anthem Health Plans just had to have been ecstatic with the news. It's been two years since the beginning of the dispute and there is still a long way to go. I loved this quote by their attorney: “Anthem cannot be allowed to unilaterally dictate a payment rate that jeopardizes the ability of physical therapists to continue to provide high quality services to the citizens of Maine.” I know I'll be cheering for the underdog! Selena (Source: MyPhysicalTherapySpace.com)

Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome.

Physiospot - Musculoskeletal — Tue, 15 Apr 2008 04:00:00 +0100

Bolgla LA, Malone TR, Umberger BR, Uhl TL The objective of this study was to determine if females presenting with patellofemoral pain syndrome (PFPS) from no discernable cause other than overuse demonstrate hip weakness and increased hip internal rotation, hip... (Source: Physiospot - Musculoskeletal)

Changes in plasma concentration of serotonin in response to spinal stabilisation exercises in chronic low back pain patient.

Physiospot - Musculoskeletal — Tue, 15 Apr 2008 04:00:00 +0100

Sokunbi O, Watt P, Moore A The purpose of this study was to investigate the changes in the plasma levels of serotonin in response to spinal stabilisation exercises in participants with chronic low back pain. Plasma levels of serotonin were... (Source: Physiospot - Musculoskeletal)

Single-point acupuncture and physiotherapy for the treatment of painful shoulder: a multicentre randomized controlled trial.

Physiospot - Musculoskeletal — Tue, 15 Apr 2008 04:00:00 +0100

Vas J, Ortega C, Olmo V, Perez-Fernandez F, Hernandez L, Medina I, Seminario JM, Herrera A, Luna F, Perea-Milla E, Mendez C, Madrazo F, Jimenez C, Ruiz MA, Aguilar I The objective of this study was to evaluate the efficacy... (Source: Physiospot - Musculoskeletal)

What is grossly missing from the analysis

MyPhysicalTherapySpace.com — Sun, 13 Apr 2008 13:41:43 +0100

Multiple choice question-something you won’t see on a PT licensure exam soon I hope. All of the following are true except: A. About 2.2% of medicare part B expenditures are for outpatient PT/OT/SLP of which 75% or roughly $3 billion is on PT. 9.7% of medicare beneficiaries access outpatient therapy. B. Data demonstrates that between 2006 there was an increase of 3.5% beneficiaries accessing outpatient therapy but a reduction of 4.7% in medicare expenditure for outpatient therapy C. The medicare cap and exemption process caused a reduction in expenditures between 2004 and 2006 D. All of the above are true statements This is not a trick question. If you were a member of congress or some type of CMS committee tasked with assessing the therapy cap and exemption process and you relied on recent reports from an entity that you contracted (CSC), you would guess D. If you work are a PT and have been forced to deal with medicare patients over the last several years, you would answer C. This is one of some follow ups on my previous post Pay for Caps. Unfortunately, the most erroneous conclusion from the CSC reports is the following: The outpatient therapy caps, as implemented in CY 2006 with the exceptions process decreased overall spending and had little or no impact on beneficiary access to outpatient therapy services, in contrast to the negative effects observed in CY 1999, This is the difficulty in having an external organization examine medicare claims data without likewise examining other changes by medicare that were enacted in the same time. This gross omission completely missed the real reasons that dollars were reduced. The following are some real reasons almost all of which are regulatory constraints or consequences of them: 1. the superimposed rules (e.g. 8 minute and group therapy) 2. enhanced auditing of claims for technical compliance which causes a “fear factor” by PT’s and thus group therapy or interventions left purposely off the superbill (throw in notable news about companies being penalized by medicare for overbilling ther ex and underbilling group therapy and this adds to this factor) 3. increased medicare patients moving away from a hospital environment to a PTPP which in turn causes increased medicare patients in those settings which in turn causes overlaps which in turn increases an increase in #3. 4. shortage of PT’s which causes more patients per therapist and underutilization There are other “real reasons” for the decrease in expenditures. Yes, the exemption process in fact is an additional regulatory constraint (let’s make sure we d/c the patient prior to them reaching the cap). Interestingly enough, only about 15% of patients in a non hospital outpatient clinic exceed the cap versus 27% for SNF versus 37% for CORF. The biggest tragedy that will be disguised as “good news” for the PT industry? You can be guaranteed that the great success of the cap and exemption process will be in place after its current June 30th deadline. Erstwhile, disruptive process and continued medicare patient “hoops and ladders” in your clinic will exist. thoughts? larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

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Vastus medialis activation during knee extension exercises: evidence for exercise prescription.

Physiospot - Musculoskeletal — Sat, 12 Apr 2008 04:00:00 +0100

Bolgla LA, Shaffer SW, Malone TR The objective of this studt was to compare vastus medialis (VM) activation during a SLR and weight bearing exercises. Fifteen healthy subjects had electromyographic amplitudes for the VM expressed as a percent maximum voluntary... (Source: Physiospot - Musculoskeletal)

Cprs in the movies: ottowa knee rule

MyPhysicalTherapySpace.com — Fri, 11 Apr 2008 21:19:03 +0100

A lot of attention has been given to CPRs that predict outcome (rightfully so). However, CPRs for the purpose of screening can be immensely helpful, in particular for PTs practicing in a Direct Access environment. Despite the fact that many screening CPRs have only a few items, it isn't too difficult to forget the items that make up the rule if the rule isn't used on a regular basis. That is where "CPRs at the Movies" come in. Several students at Texas State University put together this CPR movie that once viewed, will no doubt help you remember the items comprising the Ottowa Knee Rule. Take a look (you may even want to grab some popcorn for this one). Who knows, if there is enough interest in these we could even have a CPR movie EIM Oscar Award presented at CSM 2009. Maybe the winner could receive free tuition to an EIM course? Let us know your thoughts (and if you have a submission). Sit back and enjoy the show (cell phones off, please). Rob (Source: MyPhysicalTherapySpace.com)

Pay for caps

MyPhysicalTherapySpace.com — Fri, 11 Apr 2008 21:03:21 +0100

Forget about P4P measures as a way to control growth and ensure quality in outpatient physical therapy. According to CSC reports, the caps and the exemption process controlled growth while simultaneously did not restrict beneficiary access to physical therapists (and OT’s and SLP). Although the report which is based on 2006 data cannot identify POPTS, the reports show a decrease in spending for PT overall compared to prior years and is roughly 3 billion for the PT component (which represents about 75% of total outpatient therapy). I believe this report is a serious blow to the POPTS argument that utilization is increased. Outpatient providers of private practice (which includes POPTS) now account for roughly 27% of all claims with hospitals now at 2nd place at 20%. PTPP has roughly 42,000 providers which is 27% more than in 2004. Pure physician billing of PT via “incident to service” is much less than prior reports as the conversion to individual provider numbers more than offset that decrease. It is my opinion that the growth in PTPP is undoubtedly POPTS but as you might guess, we don’t have data to prove it. Interestingly enough, CSC’s analysis is that beneficiaries who reached the cap in an outpatient setting generally were not sent to a hospital for further treatment. Did it ever occur to CSC that this is logistically very difficult to do and that undertreatment in some ways has unintended consequences? Did it ever occur to CSC that the proliferation of PTPP in and of itself caused the decrease in spending? When you reduce the highest cost providers (that would be hospitals) and they are treated by an ever growing base of “capped” providers this would reduce cost! If they really want to save money, just forbid hospitals from seeing medicare outpatient rehab patients!!! (for the record, I am not advocating this-just extending their illogic). I am not even bringing in quality, cost-effective, or efficiency arguments between hospitals and PTPP-just logistical and growth in PTPP settings. That’s another rant for another time. I will follow this up with some points that are very different than the CSC conclusions. Including the simple argument that decreased in PT spending is not necessarily a good thing or something that should be a goal. It will always be a lot cheaper to do PT than to do surgery, imaging, and drugs. Make no mistake. We will undoubtedly be stuck with caps and exceptions process for a LONG time. larry@physicaltherapist.com (Source: MyPhysicalTherapySpace.com)

Aaoms supports physical therapy intervention

MyPhysicalTherapySpace.com — Fri, 11 Apr 2008 17:06:41 +0100

Wow! Did the APTA team up with the AAOMS? HR 5590 was introduced on March 11, 2008. I'm surprised the APTA hasn't disseminated information about this particular bill. Nice to know that another organization and dentists see value in the skill and knowledge physical therapists offer. (I hope there isn't some dream plan that dentists can increase their profit margins by including physical therapy as an ancillary service.) HR 5590 isn't completely in line with The Vision, but a bill always goes through changes, so it can be altered if anyone believes it should be altered. HR 5590 is a really short bill. Does anyone know the politics behind the scenes? Selena (Source: MyPhysicalTherapySpace.com)