"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Wednesday, February 25, 2009

75-year old man runs marathon with 'bone-on-bone' arthritis

Just this weekend I attended the Running Conference at the University of Florida Orthopedics and Sports Medicine Institute in Gainesville.

There, one of the presenters claimed to have helped his patient, a 75 year-old runner, continue marathon training and racing despite Grade IV 'bone-on-bone' knee arthritis with bi-annual injections of hyaluronic acid (chicken cartilage) into the knee joint space.

Irrespective of testosterone-laden "atta-boys!" or of wry head-shaking at old ages' folly I still want to know this:

How was it paid for?

75 year-olds generally have Medicare.

Medicare usually pays for one course (3 or 5 injections) of viscosupplementation every six months in Florida.

Hyaluronic Acid (aka viscosupplementation) pays fairly well for the course of treatment: ~$250 for specialist surgeons and ~$150 for non-specialist physicians.

I, as a physical therapist, have to show that my 75 year-old patients need physical therapy to prevent progressive disablement, loss of independence or institutionalization.

For example, I can't say that one of my patient's goals is to...
  1. Run a Marathon!
Marathon running is not "functional".

That is, racing marathons wont necessarily keep grandpa out of the old folks home.

Why (apparently) does Medicare pay orthopedic and sports medicine doctors to keep 75 year-olds running marathons when Medicare wont pay physical therapists to keep 75 year-olds running marathons.

Is there some evidence that chicken cartilage is more cost effective than physical therapy?

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Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

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