Gaston Rehab Associates, Inc. Physical Therapy and Sports Performance

Physical Therapy Choice "The Website": South Carolina PT's are some how now the bad guys?

Wow! All I can say is Wow! A friend alerted me to this website, www.physicaltherapychoice.com. It is put together by a "Coalition" and I use that term loosely, to save the available choices for patients in SC in regards to access for available physical therapy services.

You see in 2006, the legislature in SC did the right thing. They removed the ability of physical therapists to work in Physician Owned Physical Therapy offices, thus limiting the potential income to many physician groups.Why are there only 3 states who have outlawed this? Because any other state who attempts to get legislation passed is met with strict opposition from other groups with either more money or more influence.

Think declining revenue isn't a major motivation for certain groups to add physical therapy to an office? Look at the following websites as examples:

http://www.bodymechaniques.com/bodymech/

http://www.beckersorthopedicandspine.com/orthopedic-spine-practices-improving-profits/3101-5-points-for-orthopedic-surgeons-to-consider-before-addition-physical-therapy-to-their-practice

http://www.empiremedicaltraining.com/workshops/seminar_details.listevents/33/Physical-Therapy--Physician-Supervised/

And it isn't just limited to physical therapy. This was happening in the 1980's and is still happening today:

http://motherjones.com/politics/1993/05/motherjones-mj93-double-dipping-doctors

Over and over again on these websites you see a recurrent theme: passive income, increase practice profits, #1 solution to declining reimbursements. All by adding "physical therapy" to your practice. Take a close look:  outcomes, experience of the physical therapist, and the patient are after thoughts. Even this new website claiming that patients no longer have a choice in SC is not able to show real numbers that the skilled available PT workforce dropped off or that the outcomes of patients were affected. Is it possible that they are feeling left out of the "#1 solution to declining reimbursements?"

The "Share Your Stories" tab is littered with supposed "Orthopeadic Surgeons" complaining about the lack of control they now have and the limited ability for people to access physical therapy. And the fact that not one person other than "Beth" wanted their name on this website? Makes me think someone has something to hide. They want your money, but who is they? The Coalition? In the words of the folks at Fox NFL Sunday, "Come'on Man!"

In the resources section the only position statements are from the AAOS and the SC Orthopaedic Association. Where are the AMA, the radiologist groups, and all of the other physician professional groups weighing in on this issue? In 2006 this turf battle was being discussed in other areas: physicians vs physicians vs hospitals?

Here is where the American Physical Therapy Association stands on the issue.

I would like to see one day where we again thought of healthcare as care and not business. Here is what the new website should be asking you to do instead.

1. Contact your legislature to thank them for the work they do instead of calling to complain.

2. Contact your insurance company and ask for the same copay/co-insurance whether you are seen in an office or a facility. Hospitals and physician offices typically get paid more under the current calculations (cost to deliver care is supposedly higher so they get paid more) although your co-pay/co-insurance is typically lower than if you went to an outpatient physical therapy practice owned by either a corporation or a PT.

3. Find out the real reasons the laws (Stark Laws) were written. Under Medicare guidelines physicians are prohibited from making referrals of patients to entities for which they have financial interest in. Physical Therapy is listed under this section. This is a Federal Issue.  That is why the laws are referred to as Physician Self Referral laws.

4. Ask your physician/referral coordinator why they are referring you to a certain physical therapist. If their answer is convenience, because we know them, or because they are the best, ask if the physician has any financial interest in the company? If yes, understand that you have options and there may be other PT's out there. Real facts from a third party source

Last but not least, physical therapists are licensed individuals many of whom are educated at a doctorate level. There are State Boards who govern their actions, just like physicians. NC and SC law allows for a patient to self refer themselves to physical therapy without ever having been to a physician. This is seen by many physician groups as going against the traditional medical model because it does not follow tradition. The old HMO style of "gate keeper" has been proven ineffective by needing a referral to specialist from a primary care physician. Why do you think more medical students are going into specialties and not chosing primary care any longer? Physical Therapists are experts in movement and movement related disorders. For the same reason you would not go to a Cardiologist for a Chest Cold or Diabetes management, you would not go to a Physical Therapist for these either.  But for muscle pain, joint pain, poor posture, walking problems, and any other movement problems or deficits, why would you not choose to see a physical therapist first. Physical Therapists are medical professonals and are another part of the medical team and should not be used to supplement income!

 

 

P90X(R) vs. Traditional Workouts

I get a lot of questions from patients and friends alike about P90X(R). Most ask first, "do I know anything about it," followed by "does it work."

Let's take a step back and look at exercise and how it has evolved over the last 40 years. Nautilus equipment was first introduced to the public in 1970 at the Mr. America Contest. A new approach to the way we worked our muscles and officially "worked out,"  was introduced by Arthur Jones because he perceived other training equipment to be "limited and often times flawed."

Another company and producer of fitness equipment, Cybex International started into the fitness industry in 1983 after purchasing Eagle Performance systems. Today Cybex machines can be found in more than 650 YMCA's across America, along with countless other gyms and wellness centers.

While there are more companies producing fitness equipment, these are probably the two most recognized for their lines of fitness equipment found in gyms in the US. What these two companies may have also done is help to launch a multi-billion dollar a year gym industry by opening up weight "lifting" to the masses. No longer was it necessary to use "good form" or "know how" to properly lift a dumbbell or barbell. There were now machines which isolated the muscles/joints and pictures to show you how to use the machine correctly. This was "lifting for dummies" and the craze for health clubs began.

Unfortunately what it also did was change what we as Americans perceived as "working out." Now in order to gain access to this equipment you had to join a health club or go to a gym to use it. No longer were you able to just work out in the privacy of your home or go to a park to work out. We had that for years and now this equipment was something "new" and "flashy." Machines were the sexy way to work out and even women could now join in; at least that is what the manufacturers wanted us to believe!

Throughout the years fitness equipment and home workouts have come and gone. Who can forget the Thighmaster, the ab lounge, the ab-rockers, 8 min-Abs, HIp Hop Abs and Sweating to the Oldies to name a few of my personal favorites. Sometimes the local gyms would prescribe to the notion and get on board and sometimes not. I remember using ab-rockers at a local gym in the early and mid 90's. The industry seems to always be changing, but for whatever reason gyms have never left their old stand by of weight lifting machines. And heck why not. You know what you are getting and nothing can be easier than sitting down or standing in front of a machine and changing the pin in the weight stack to increase or decrease the amount of resistance you feel. Imagine if all gyms removed all of the equipment and tried to sell memberships? I would suspect a very large drop in revenue would occur.

So flash forward to today and the P90X. Does it work? Of course it works, but not for everyone. P90X is marketed to the masses by Beachbody the same company that brought us Hip Hop Abs(R). Tony Horton is absolutely ripped and takes you through a very comprehensive series of exercises designed to build strength, endurance, flexibility, and power. The nutrition component has you eating like a professional body builder. What more could you ask for in a program that is relatively inexpensive and is comprehensive?

The problem is that like all things designed in the "one size fits all" category we must realize that not everyone will see the same results and we also have to take into consideration that the same results or maybe even better results may occur from different forms of training. What if you have a chronic medical condition or an inability to move certain body parts because of previous injury? Unfortunately Tony Horton is not there to provide individual support and feedback for you every step of the way. This is not a knock against Tony or Beachbody or any other fitness "guru" gone celebrity with a DVD or video, it is just a matter of fact. Also some people are only motivated by the social aspect of "working out" and have to force themselves to get out of the house in order to work out accordingly. These people will not see any benefit by turning on the DVD player and getting into position in front of the TV.

I have long stood by the notion that the best workout is the one you do and do consistently. I also believe that the best workout is only as good as the effort put into it by the person performing it. If everyone put an hour a day into performing a high intensity workout with resistance we would all see improvement. P90X or any other pre-designed program for that matter, if used by someone who has no health issues, is motivated to improve themselves, and has an hour or more a day to do workout, will work. If the description I just provided does not sound like you, then you may want to look at other options.

Chiropractors hiring Physical Therapists and Going to School to Be a PT Aide

Chiropractors hiring Physical Therapist's:

Advanced Rehab Consultants has apparently figured out how to effectively add income to Chiropractor's practices. Their "so called secret?" Add physical therapy. My guess is that they will not be getting too many clients in CA, NY or any other places where the reimbursement for PT services is almost the same as the PT hourly rate. I guess they figure if Physicians and other Health Care companies are doing it, why not make money by teaching Chiropractors to learn how to manage other professional staff and bill for their services.

May I suggest that Chiropractors and Physical Therapists work together rather than for each other, if a desire to do so does exist. Sharing expenses (rent, front office staff, clinical supplies) will ease the burden of any office and while it does not provide for an "endless cash flow and the ability to finally take a vacation" it does provide a step in the right direction for building relationships with other health care providers.

PT Aide School:

Penn Foster Career School of Scranton PA, oh my beloved PA, has apparently found a way to lure people back to school. With the economy the way it is and people looking for jobs, apparently Penn Foster wants to make sure it is there to receive the economic stimulus funds and people's hard earned money. They now offer a Physical Therapy Aide on-line training program. In as little as 4 months (an hour a day) with an optional "clinical experience course" they will provide you with everything you need to know.

Cover these topics and more:

• The role of the Physical Therapy Aide in patient recovery
• Common physical disorders
• Physical therapy treatments
• Exercise and mobility training

And you’ll learn it all at home — no classroom needed! You’ll get valuable information about Physical Therapy Aide training issues from lifting techniques to environmental safety, plus a clinical work experience option.

Start a rewarding career in a growing field.
Why take the Penn Foster Physical Therapy Aide training program? With the right credentials, you can:

• Be an important part of a professional physical
  therapy staff.
• Work at a hospital, physical therapy office, personal
  care facility, or with a home health agency.

My favorite part is the "learn it all from home with no classroom needed."

Now I can't single out Penn Foster as there are a few others offering the same sort of PT Aide on-line training program. I actually had a woman call my office (and I am glad she did) to ask about the legitimacy of these programs. She wanted to know if we hired Aides and was it better to go to school to become a Physical Therapist Assistant vs. a PT aide? I had honestly never even heard of going to school to become a PT Aide.

By definition a PT aide is anyone who is not licensed as either a Physical Therapist or Physical Therapist Assistant in the clinic. Athletic Trainers are often relegated to that of "Aide" if working in PT clinics, but even they at least have a Bachelor's degree or higher and are working diligently to change their position since even they are licensed individuals. Aides are generally high school educated with some college but they don't have to have any formal education and are often used for clerical work, clean up, and assisting with patient transport and transfers. All of this has historically been learned on the job.

In some cases Aides are used for teaching exercises, for performing range of motion, and for providing care, but these are often cases in which health care fraud is being committed since the care provided is generally billed out as if a licensed PT or PTA was providing the care and not the aide. In fact, Medicare has strict rules about who can provide physical therapy services to Medicare beneficiaries and collect reimbursement. They specifically have rules against aides providing "skilled care." I know some PT's who disagree and say we should be able to delegate to whomever we so choose, PTA/aide, but as the co-owner of a private practice, I could not sleep at night knowing that I was charging the same co-pay and receiving the same reimbursement for care provided by an Aide with no schooling (or 4 months of schooling now) versus a PT with 4+ years of schooling.

Maybe going to school to become a PT Aide is like Bartending school. Yeah they tell you they will teach you everything you need to know to become a bartender, they just don't tell you that you don't need to go to school to learn what they will teach you. If you or anyone else you know is considering going to PT Aide school, send me the $800 and I will let you work in my clinic for 2 weeks and provide you all of the on-the job training you need. The way I figure it, I would have had to pay you $10 an hour and at 40 hours a week that adds up to $800. If I don't answer right away, just leave your credit card number on my voice mail and I will get back to you as soon as I am done helping another client.

Utilization Review Groups: Are they necessary?

Utilization Review Groups (URG), pronounced "ugh" by those in the health care profession, are much like HMO's; no longer necessary. For those unfamiliar with URG's, they were designed to manage care and were in early concept something that appeared to be a cost effective solution for employers. A company is  approached by a URG to handle their workers comp claims. The URG contracts at a set rate to handle the claim from start to finish in regards to finding providers to see the injured employee and then handle the payment of the services provided. In theory this would work well in regards to the employer not having to find health care providers for their clients and then also not having to worry about follow up and care for their employee until they, the employees, were ready to come back to work.

Sounds good in theory. Unfortunately the only article that I could find about URG's was published in the New England Medical Journal (NEMJ) in 1995. A lot has happened in twelve years. URG's were too new at the time to have any real world data to assess how well they actually worked.

Even with the strong argument that utilization is driving health care costs rather than prices alone, do we need still need URG's? My answer is "NO".

Let me explain by giving an example from the description above in regards to the physical therapy setting. A company that classifies themselves as a URG contacts a local employer. Say they convince the employer to contract with them on an as needed basis for any workers comp claims.  They reach an agreement on the price at $1000 a claim. What the URG will then do is look to find the lowest bidder from the local physical therapy providers to farm this claim out to. Why? Because the lowest bidder takes less of the $1000 and leaves more in the URG coffers. All the while the URG gets paid for what? Doing the leg work of establishing relationships with themselves and with lowest bidding physical therapy providers and with employers.

The folks at the URG make a few phone calls, send some E-mails, and then close the case out when the health care provider feels the client is appropriate to return back to work. Meanwhile it adds more paperwork, time to take phone calls, and reduces amount reimbursed for services to the physical therapy provider. It also adds administrative costs to the work comp claim because the URG has now inflated the actual cost of care.  What is even worse is that the employer is now trusting that the care of their employees is being performed by highly trained qualified therapists. While it may be the case in some instances, most of the time the lowest bidder is not the best provider. If quality costs, why would the therapy group provide quality care for less money then it costs to perform?

A better, more functional scenario would be this. Employers establish relationships with local health care providers and physical therapists especially. Once the relationship is built, the communication lines stay open. All employees that are hurt get sent to the practice where a relationship is established. Necessary care is provided and the employee returns to work. No middleman, URG, asking for duplicate notes, taking up treatment time by calling, and no excess administrative costs. Also relationships are established with the best providers in town, the employer knows their employees are being taken care of, and they can manage their own costs by establishing reasonable rates for services provided without the hassle of talking through someone else.

So if URG's are not needed why are there so many in existence? I guess bad habits are just hard to break and it is easier to pass the responsibility to someone else.

Michael Gerber: In the Dreaming Room

I had the privilege to sit in on a conference call with two business professionals that have had an impact on my life even though I have never met either one of them. Michael Port, the author of the book, "Book Yourself Solid" and Michael Gerber, best known for his book series "The E-myth" and owner and founder of E-myth Worldwide, were both on the line with Port interviewing Gerber about his new book "Awakening the Entrepreneur Within."

What I took from the call was that we are never too old to be creative and that we all have the capability to create something. Michael Gerber believes that for some reason most of us view creativity as an ability that only a select few possess. In his new coaching sessions called, In The Dreaming Room, he encourages all of us to find what our dream is and to make it become a reality. Gerber related that he himself is never satisfied in believing that all of his dreams have been accomplished and when he thinks he has, he has to sit down again and dream even bigger.

During the live conference call Michael Gerber also made a proposal to anyone that was interested. He states that if you purchase 75 copies of his new book and distribute 74 of them to business colleagues and others you may or may not know he will invite you to attend the "In the Dreaming Room" workshop for no additional cost. Not too bad considering this experience usually costs $3000.

If you are an entrepreneur and you have never read "The E-myth" or "Book Yourself Solid" I highly recommend them both and I highly recommend you read them very soon.

DoingFine: the why behind the post

If anyone read this posting previously it was entitled DoingFine. Why I decided to post this link in the first place was based on an E-mail that I personally received from a marketing company, Polimedia, asking if the DoingFine web site could pay to advertise on this blog. After contacting a friend who does web marketing she said she would be inclined to try it as many companies are now approaching blogs for advertising space.

So I figured what did I have to lose? The company said they would pay based on the traffic drawn to their site and would do a one day audit to see just how many people did actually go to their site based on the link provided (should be the first clue). Well I guess not enough people went because I never heard anything back from Polimedia. So here I am taking the link down and changing the post. You never know until you try, but I also question how long a marketing company can survive behind asking for advertising space claiming they will pay, but only after they determine how many people show up. I guess it is like saying I will work on the clock, as long as I get to keep track of the clock.

Maybe I should try that with the newspaper and television stations we advertise on. I wonder how they would respond if we said, "we would like to run an ad, but we will only pay you if people actually show up at the door." My guess is that is the reason why I still have to pay each month for our advertising. Oh well fool me once and I get something new to ponder.

Professional Encroachment? Part 2

I have noticed that my post titled Professional Encroachment has been the most viewed post on my blog and even made it to first page in Google search  for the term (from what I understand according to my website developer, if you make it to first page Google you have done something good). Perhaps, before I go patting myself on the back, maybe it is because I have touched on a topic which others are not willing to discuss openly. 

According to the Free Dictionary online: Encroachment is a noun and is defined as:

Any entry into an area not previously occupied.

The word encroachment has a negative connotation. Synonyms include invasion and intrusion. People get upset when someone tells them they have encroached upon something.

To put this in perspective, what would your first instinct be if I stood in front of you, put my hands on your shoulders and started to push? My guess is that you would want to push back? Seems natural of course. Now what if I reached into your pocket without your permission and started taking money out of your wallet. You would of course want to stop me. Again makes sense.

But what if I stood by your side and put a hand on your shoulder and pushed you forward? What would your instinct be? Now if someone just asked for volunteers to do something no one wanted to do you might push back. But what if someone said they wanted to recognize the first person to come forward with a reward and I pushed you, would you still push back. My guess is not. Why?

In the first scenario I am standing in your way and pushing you back. From a psychological perspective this is a very confrontational scenario one in which I am "blocking you" by standing in front of you and not only that, but am pushing you "backward." In the second scenario in which I am standing by your side or even behind you, this is much less confrontational and even more of a supportive stance. My push "forward" is an advancement toward something and no longer a push "backward" or "away" from something.

If I have built a relationship with another person and have permission, whether implied or through direct communication, to enter the space they already occupy then it is no longer considered encroachment. Plain and simple.

So how are relationships built? Relationships usually take time and are built through trust, honesty, communication, a common goal, a purpose from which both parties benefit and so on. How are relationships destroyed? In real life if a true relationship exists it really is harder to destroy a relationship than most believe. Unfortunately too often we have casual "relationships" with acquaintances which can be in both business and in our personal life. This casual "relationships" are from what most of us draw experience on "relationships" and on which we base most of our decisions. If an actual relationship existed, one that was formed on the trust, honesty, communication, a common purpose or goal as mentioned previously, a little thing like misinformation would not ruin the relationship so easily. In casual relationships one piece of gossip or he said she said is often enough to break ties for good. I am sure we have all had this happen before. We hear from a friend that another person we thought was a friend was talking about us behind our back? (Remember this in high school?) How many of us still talk to those people? My guess is that if it was a true relationship that unless distance and/or life crept in we are still talking to those people, if not thinking kind thoughts about them.

So why did I use the term professional encroachment in regards to the NATA lawsuit against the APTA? When you look at the relationship that has been between the NATA and the APTA it has been one viewed from all parties as confrontational. The APTA is not willing to stand side by side if the NATA is looking to move into space that the APTA feels their members are already in. If Athletic Trainers (as their name implies) wanted to just work with sports teams and stand on sidelines  and in the training room doing the excellent job they are trained to do then the APTA would never have had an issue with this.  The job like  physical therapy evolved from a need. The athletic trainer was needed to help athletes. The athletic trainer is highly educated in their field. But where does their field start and the physical therapist field stop? That is the million (or couple million dollar question) at hand.

There is a gym in town that offers "Functional Therapy" for active people. It is owned and staffed by athletic trainers who are strength and conditioning specialists as well. They tell me that they are more than educated to provide treatment to active people of all ages and not just those that consider themselves athletes. Unfortunately what they don't tell people is that they are athletic trainers. "Functional Therapy" sounds better I guess. I have had at least 5 people come up to me and tell me that the therapist at that gym implied they did physical therapy and actually all thought these guys were physical therapists.

So the NATA wants its members to be able to provide "incident to" therapy services with Medicare (note not "incident to athletic training services") and expects the APTA to stand by and let professionals with dual licensure teach others with only one license (ATC) certain treatments. Am I wrong?

My question is why are they not fighting so hard to tell the public that Athletic trainers do athletic training and that includes a lot of the same things that physical therapists do and exercise physiologists and personal trainers and so on? My guess is that on its own without legislature, they would not have a basis for this.  My understanding and maybe I am wrong, is that if you want to do something you go get the appropriate degree for it. Those dual licensed PT/ATC individuals didn't start a lawsuit to avoid having to go back to get another degree. They chose to go get another degree and paid their dues. I bet those individuals would be pretty peeved if they were told they didn't have to go back to school and were now able to do what both degrees allowed them to do before without the degree. As for all of these examples of people with their ATC and exercise physiology degree another example of what I am talking about. Same person went back to school for two different degrees. Any person that claims that their physiology was different is ignorant and anyone that claims that CPT codes stand for Physical Therapy codes is severely misinformed. Take it for what it is, blame the person not the profession. Professional Encroachment is taking something that someone else is already doing and trying to do the same thing. How would you feel if you got pushed?

Access to Books online with Harper Collins

Harper Collins Publishers has decided to allow readers to preview books online for free. You can even use the book widget to paste books that you are reading into your blog for others to read. I like where this is going and  believe this could really catch on. Below is a sample from the book Freakonomics by Steven Levitt and Stephen Dubner. Anyone else have any good books they have read and want to share?

Playing Circles

Steve Chandler in his book 100 Ways to Motivate Yourself  discusses a great way to keep focus. Steve points out that it takes about four minutes a day and only four circles. Sound simple enough? Well it is.

The first circle is your lifelong dream. This is the ultimate goal you wish to achieve. It can be money, fame, education, whatever. This is the largest circle and the one the other three lead to. The next smaller circle is called "My Year." In this circle the goal is to list what you need to do in the year to accomplish the ultimate dream.

The third circle is labeled "My Month." In this circle you place what it is you must do each month to reach "My Year." And in the fourth and final circle, called "My Day," you would place whatever it is you need to do on a daily basis to reach "My Month."

When broken into small bite size pieces any goal is attainable. Every athlete who has ever broken any scoring record has started out at zero and worked their way through each of the four circles to get to their ultimate goal, whether they knew it or not.

I love this method of goal setting. Let's use it in an example for losing weight. Say you would like to lose 75 lbs. If you lost one pound a week over 75 weeks you would reach your goal. So the largest circle would be lose 75 lbs. The second circle would be lose 52 lbs. this year. The third circle would be lose 4.3 lbs a month. And finally the 4th circle is the more detailed circle.

If we know that it takes 3500 calories to make a pound of body fat we can then further break it down to smaller chunks and list out the fact that it would take 500 calories a day to be either burned off or taken out of the diet in order to obtain the "My Day" goal. By making this goal you know that each day if you want to obtain the ultimate goal you must burn or not consume 500 calories. This sure sounds more attainable when broken down than it did in its original form of 75 lbs.

What else can you think to use this concept for?

New Website

A new website BigThink was launched today. Designed to get discussions started and act as a think tank on the web, the premise of this website is to allow for social networking for those people that may not find exactly what they are looking for on YouTube or MySpace.

It will be interesting to see what happens with this site and if it does take off.