"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

Sunday, April 5, 2009

A crisis in Physical Therapy?

Rahm Emanuel, the current administration's Chief of Staff wasn't the first one to say...
"A crisis is a terrible thing to waste"
...but he may go down in history as the one who gets credit for saying it, especially since he is already being quoted in the April 6, 2009 Newsweek as the one who said it.

Emanuel was iterating the point that right now is a great time to try new ideas to reverse past mistakes and reverse inequities in the current system.

Health care has made some mistakes and has some inequities that might be improved a bit.

Health care has room for some new ideas.

A Call for New Ideas

The latest (April 2009) edition of Physical Therapy Journal has an article by Shumway-Cook calling for a standard platform for the examination and intervention in patients at high-risk for falls.
"These findings suggest a need in the profession of physical therapy to identify and implement a consistent approach to management of falls due to physical factors such as reduced strength and impaired balance and gait among older adults."
Right now the profession is left to invent 'homegrown' methods for many examination measures, interventions and outcomes. Only 48% of physical therapists in the US use standardized outcome measures to assess baseline status and progress in their patients.

Don't misunderstand, I approve of invention and innovation - but I also need standardization. So do our patients.

Can it work?

There is substantial literature that shows physical therapists are able to identify persons at risk for fall and other disabling conditions before they suffer an episode and before they perceive a limitation.

Perhaps our screenings should encompass more than falls risk - perhaps we should look for limitations that hinder a persons ability to work and play to their fullest extent.

Many of my patients tell me that they are 'normal' - just 'old'.

We now know the following...
"although older persons did not perceive a limitation in performing certain tasks, they performed certain tasks less often" (Jette A, JRRD, 2007)
Try this on

Tax credits for older persons who pass certain validated and reliable performance measures administered by physical therapists.

For example:
  • Timed Up and Go Test
  • Functional Reach Test
  • Balance and Reach Test
  • Timed Tandem Standing
  • Timed Single Leg Standing
  • Timed Rhomberg Test
The expected health care savings (from reduced falls, fewer hospitalizations, less institutionalization and morbidity/mortality) would have to be estimated while the amount of the credit would be a real cost to the Federal government.

The amount invested (the difference between the cost and the estimated savings) could be compared to the amount now spent for proposed and existing programs, such as PQRI.

The upside

Physical therapists gain direct access to a new patient base that will see immediate benefit from our interventions while the government gains cost savings and a healthier, more productive, citizenry.

The patients wins all around.

It's time to stop wasting time.

What do you think?

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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 .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

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Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.