"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 23, 2011

Three Important Trends in Physical Therapy

Electronic everything. I sound grandiose but I just got back from the 2011 HiMSS (Health Information Management Systems Society) meeting at the Orange County Convention Center which must be one of the largest buildings on Earth. No kidding.

The tools and toys displayed in that building connected the patient to the doctor in every conceivable way: email, phone, text, real-time, trending data, graphics displays, historic data, tablets (7" or 10"), iPhones and many I didn't get a chance to see.

These vendors are betting big that healthcare will converge with electronics in a big way in the next 5-10 years.

Information technology professionals are betting that Health Care Reform will withstand the challenge of the 112th Congress and continue to be the law of the land. Recent Federal appeals court decisions put the tally at 3-2 in favor.

These vendors are ready to capture the $29 billion dollars to be paid out over the next 5 years in HITECH funding for doctors to invest in electronic medical records.

Imagine the future when you get paid based on your ability to predict future adverse events in your patients - and prevent them!

Important, life-changing events like stokes, falls, spinal fractures, blood clots or future disablement and institutionalization can now be predicted by physical therapists using simple, evidence based tools.

At HiMSS, they want to make these tools electronic and as easy to use as your e-mail account.

Care systems built around patients, not doctors. Our American healthcare system is built for the convenience of physicians with 15-minute appointments, fee-for-service and isolated silos of practice and knowledge that leave care fragmented.

The future system will be built around patients' needs, not physicians.

Atul Gawande, MD described in Hot Spotters how unlicensed health coaches can prevent outlier patients from slipping back into bad, old habits and ending up in the Emergency Room for costly care.

James K. Galbraith describes in The American Prospect how expanding the pool of healthcare workers will improve not just our health but also our economy.

Dr. Galbraith proposes expanding, not cutting, Social Security and Medicare, as a way to stimulate jobs in areas that are unlikely to migrate overseas or disappear when financial winds blow ill:
"Another area of clear need relates to our aging population.
As people get older, they need care, and the proportion of the working population employed in providing it must rise.
Further, training is necessary, and standards must be imposed, maintained, and enforced.
This is the opportunity to create a large, labor-intensive, mainly not-for-profit sector, that would employ workers with relatively nontechnical backgrounds and help the elderly live in independence and comfort for as long as possible.
Again, realizing this goal will require new institutions or stronger versions of institutions that already exist."
Increased role of non-surgical providers: I can't find any good news coming from the medical literature on aggregated outcome rates for surgical procedures or diagnostic imaging.

Despite the continuous advances in technical proficiency American medicine has exhausted its ability to help patients by ionizing, radiating, poking, cutting, slicing, stabbing, laser-ing or cauterizing the body.

Quality of Osteoarthritis Management and the Need for Reform in the US describes the pathetic record American healthcare has produced:
"Surgery should be resisted when symptoms can be managed by other treatment modalities.
At present, there is no metric whereby the use of conservative management prior to surgery is monitored."
Physical therapists familiar with this blog and other blogs will appreciate our position.

I'd like to recommend that physical therapist entrepreneurs attempt to enter the electronic space and create decision support technology that can distinguish surgical patients from conservative care patients.

Take a look at our hybrid Clinical Decision Support system - we "married" it to my EMR in a shotgun wedding - the baby's not pretty but, hey, we're family...

Its free to use - just call me or e-mail me to set up an account. Play with it using the demo account Username: joey, Password: test123. This is, to my knowledge, one of just a few CDS systems oriented to improving quality, rather than charge capture.

Further, most of the EMR/CDS systems on the market today are built and sold by a small concentration of IT companies. Large companies with large market share are seldom known for their innovation, are they?

Free Tutorial

Get free stuff at BulletproofPT.com

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.

Share PTD with your Peers!

American Physical Therapy Association

American Physical Therapy Association
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.