Will Screening for Pathology by Physical Therapists Lower Surgical Rates?

Direct access to physical therapy services is safe and effective for patients with musculoskeletal problems, like lower back pain.

Physical therapists can screen for ominous findings, such as cancer, with a predictive accuracy that meets rates by diagnostic imaging, such as x-rays, MRI or bone scans.

"Among patients who develop epidural spinal cord compression, those who are diagnosed early, while still able to ambulate, are the most likely to remain ambulatory following treatment.

The ideal diagnostic strategy would detect the few cases of cancer among primary care patients with low back pain, while minimizing unnecessary diagnostic testing."

Physical therapist early intervention may reduce unnecessary, expensive and risky back surgeries if two conditions are met:

1. Over-diagnosis of pathology by physical therapists detected in the screening examination is not sent for unnecessary diagnostic imaging, and...
   
2. Patients attitudes and choices regarding "risk free" surgical fixes do not continue to increase.

A recent study from Norway on the effect of population screening for breast cancer in 35,408 women found that screening increased that rate of surgical mastectomies in two of the three age groups.

According to the study authors:

"The objective of mammography screening is to improve the timing of breast cancer diagnosis, thereby reducing the number of associated deaths.

A potential additional benefit often stated in invitations to screening and on websites supported by governmental screening institutions is that screening reduces
the need for mastectomies and increases the potential for breast conserving treatment."

A corollary for physical therapist screening suggests that early detection of pathology and subsequent appropriate treatment should reduce unnecessary treatments, including hospitalizations, re-hospitalizations and death.

The recent meeting of the Florida Physical Therapists in Private Practice, attended by 81 private practice physical therapists, looked at physical therapist screening to reduce healthcare costs and improve outcomes under Medicare Accountable Care Organizations.

Diagnosis by physical therapists will be an important part of America's future healthcare system.

How much the physical therapists' diagnosis improves patients' lives and reduces system costs will determine the value physical therapists bring to this future system.

Wellness Programs Are Not Poular Among Hopital CEOs

Hospital CEOs say that their wellness programs are "nice to have" but they are not getting paid for them.

As one hospital CEO puts it:

“I’m not getting paid for it so it goes to the bottom of my priorities.”

Hospital CEOs should pay attention to the practice of many physical therapist leaders who are positioning their organizations to impact patient health in a way that will impact population health.

Population health are the set of metrics that look at how physical therapists' interventions actually make a difference in peoples' lives:

• Are patients happy with their physical therapist? (#4)
• Can patients go back to work? Can they play with and lift their babies up? (#7)
• Did the doctor/therapist ask about or measure the following:
  
  • their weight? (#31, #47)
  • their Blood Pressure? (#32, #41, #58)
  • their tobacco use? (#33, #38)
  • did the the PT screen them for depression? (#34)
• Did their physical therapist screen for future falls risk and implement a plan of care? (#63)

As you can see, there are many of the 65 ACO Quality Measures that physical therapists can impact.

Payment may change as Medicare Accountable Care Organizations (ACO) begin in 2012 to pay providers based on outcome, not volume.

Wellness programs have great potential to impact some of the biggest, modifiable drivers of healthcare consumption:

• obesity
• smoking and alcohol consumption
• activity avoidance
• mood disorders.

Medicare Accountable Care Organizations have hospital CEOs fretting about their 2012 revenues since the new program gives hospitals the incentive to cut costs on some unnecessary procedures.

Medicare will reward hospitals that save from 2% to 3.8% of their prior year's revenues up to 7.5% of the "shared savings".

Forward-looking CEOs are aligning their organizations to achieve shared savings since the only alternative is steep, permanent cuts in Medicare and commercial reimbursement.

Forward-looking physical therapist leaders and clinic owners should also seek to align their organizations in a wellness model that impacts the biggest health care driver of them all:

Patient behavior

How can we help people who may not be able to help themselves?