"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, January 26, 2011

State of the Union: Healthcare Reform 2011

On Thursday, Jan 27, 4:30 PM Eastern, Medscape will participate in a roundtable discussion in our nation’s capital.

They will be bringing you the pressing questions about healthcare reform to the White House, and they're interested in hearing from you.

Visit Medscape.com to submit your question. Here is the text of my question:
"Evidence of overutilization of diagnostic imaging and specific surgeries implies that physicians and hospitals make treatment decisions based, at least partly, on financial gain.

Many of these physicians are paid based on the volume of care they provide.

In 2014, hospitals will begin organizing Medicare payments into fixed payment (capitated) Accountable Care Organizations (ACO) which will be directed by the same group of physicians and administrators.

What mechanism will compel this group to switch from the current volume-driven model to a quality model?

One proposal I would like to make is de-centralizing the decision making to appropriately trained providers, like nurses, physician assistants and physical therapists.

Most of these professionals are paid a salary.

A mix of incentive-based physicians and salary-based professionals acting as primary care providers could prevent overutilization but also guard against "stinting" on care under the fixed-payment ACO model.

Physical therapists are not currently included as eligible professionals under Medicare Accountable Care Organizations (ACO).

Physical Therapists are trained to manage high-resource use chronic patients that tend to use lots of healthcare (doctor visits, hospitalizations and surgeries).

Physical therapists can keep these people in their homes - the lowest cost setting in all of healthcare.

I recommend including physical therapists in Medicare ACOs and decentralizing the decision making away from the "status quo".

Thank you,

Tim Richardson, PT
Do you have a question?

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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.