"Stealing" Patients from Physicians, Part 1 of 3

Right now in America, most physical therapists accept referrals from physicians for conditions like simple ankle sprains and lower back injuries.

What if I told that soon, physical therapists will "steal" these patients from physicians' caseloads?

And, physicians will thank us for stealing their patients.

How can we do that?

How can physical therapists steal patients from physicians and get a big "Thank You" in return?

By following Clayton Christensens's "rules-based medicine".

Rules-based Medicine

"Rules-based" medicine is described in Harvard professor Clayton Christensen's Innovator's Prescription (2011)



Professor Christensen describes a clear process by which professions inevitably transform their bodies of knowledge upon which they are built from an art into a science.

Rules-based medicine is the "technological enabler" that physical therapists need to "steal" physician market share

"Work that was once intuitive and complex becomes routine, and specific rules are eventually developed to handle the steps in the process.  

Abilities that previously resided in the intuition of a select group of experts ultimately become so explicitly teachable that rules-based work can be performed by people with much less experience and training... 

The term "technology" that we use here refers to... mathematical equations (algorithms)...  

However, at the heart of this evolution of work is the conversion of complex, intuitive processes into simple rules-based work, and the handoff of this work from expensive, highly trained experts (physicians) to less costly providers (physical therapists, nurses, physician assistants, etc.)."

Clinical decision rules are available now which can help physical therapists diagnose the following patients BETTER than the unaided physician:

• acute stroke in dizzy patient
• foot fracture in trauma/sports patients
• ankle fracture in trauma/sports patients
• knee fracture in trauma/sport patients
• pneumonia in community-based patients
• spinal fracture in older patients with lower back pain
• cancer in patients with lower back pain

"Stealing" market share may be an uncomfortable concept for private practice physical therapists who have been accustomed to close, collaborative relationships with family physicians.

The primary argument against Direct Access legislation is that patient are not safe to see a physical therapist without a physician referral.

"Stealing" Patients from Physicians, Part 2 of 3 will discuss who is currently "stealing" market share from our physician colleagues.

They are getting GREAT outcomes and making money, too.

Ready, Fire, Aim: The Case for CoPayment Legislation in Florida in 2012

Passion.

Florida needs passion in 2012.

• Without passion we will not have legislative success.
• Without passion, we will not have increased grassroots support.
• Without passion, we will not have more donations to our Political Action Committee.

The three "hot topics" from the Austin, Texas APTA State Payment and Policy Forum on September 23-26, 2011 were these:

1. Direct Access (Texas)
2. POPTs (California)
3. Co-payment legislation (Kentucky, New York and New Jersey) 

Texas
Texas raised $60,000 over-and-above it's typical level of PAC donations for its Direct Access PAC in a highly public and highly controversial legislative session packed with hot button issues crowding the media:

• illegal immigration
• concealed carry permits for Glocks on college campuses
• innoculating 6th grade girls with HPV vaccine

The Texas Physical Therapy Association (TPTA) rose above these emotional issues with a carefully orchestrated public relations campaign that emphasized the Texas consumer.

The TPTA also excited over 500 physical therapists and physical therapist assistants to travel to the Texas capitol for Rally Day in support of Direct Access legislation.

Incidentally, Texas also excited the mainstream media (television) to broadcast news stories about direct access to physical therapists.

California
California lit up the physical therapy blogosphere in 2011.

California also lit up the print media in Los Angeles and, according to Paul Gaspar DPT, legislators' colorful language lit up the California capitol, Sacremento. (Incidentally, the original, Spanish name for Sacremento was "Sacred Mind". I wonder how sacred was the legislators' language? :)

California raised over $100,000 in direct POPTs PAC support from AROUND THE NATION. Not just California. That's passion.

Not only did California excite the nation, generate passion from physical therapists and raise buckets of money but THEY ALSO WON! POPTs are now illegal in California.

Now, California physical therapists just need enforcement of the new, anti-POPTs legislation.

Kentucky
Kentucky was a slam dunk! The Kentucky House voted 98-to-zero to approve physical therapy co-payment legislation.

Dave Pariser, PT, PhD was partying hard in New Orleans in February 2011 and he had to come home when he heard that a groundswell of public and legislative opinion had arisen in favor of CoPay.

Dave had to come home to shepherd SB 112 through the Senate. It squeaked through, 30-to-6, in favor. Thanks, Dave and to the KPTA.

The actuality was that the KPTA had NO INTENTION of Kentucky CoPay legislation winning ANY support in 2011. But, it did. Why? Passion.

This time the passion was from the Kentucky consumers. They wanted relief. They wanted relief from the gradual shift that insurance companies and employers had placed on employees' copays.

Kentucky voters wanted Co-payment legislation in 2011.

Florida
Florida needs passion in 2012.

The stated intent of the Florida Physical Therapy Association, from the FPTA Assembly on September 24th, 2011, is to move forward with Temporary Licensure for Physical Therapy Students. While Temporary Licensure is important, its definitely not passionate.

Without passion, the Florida Physical Therapy Association (FPTA) will get nowhere in 2012.

Temporary Licensure will not be effective in 2012 for the following reasons:

• Student don't have money to donate to the FPTA PAC for Temporary Licensure .
• No one else is going to donate to the PAC (above 2011 levels) for issues that they're not passionate about.
• Controversy is necessary to raise physical therapists above the media fray - don't be afraid of controversy.
• Controversy sells - PAC donations are driven by emotion, not logic.
• Grassroots support will arise when physical therapists appeal to the consumer/patient

 
My pick for Florida in 2012 on a platform of Temporary License legislation:

• Flat to negative Political Action Committee (PAC) donations over 2011
• No rally in Tallahassee with 250 therapists supporting Temporary License legislation
• No grassroots support for Temporary License legislation
• Odds of successful passage of Temporary License legislation, 3-to-1 against, that is, 25% chance of passage.