Washington State Physical Therapists Go to Battle

Columbia Physical Therapy in Washington State has filed a lawsuit against Benton Franklin Orthopedic, a group of orthopaedic surgeons, in what figures to be the next big referral-for-profit / physician-owned battle in the physical therapy profession.  The physical therapists have an interesting set of laws on their side, the physicians have the normal repertoire of “doctor’s know best” arguments on their side.

However, the attorney for the orthopaedic group might have underscored the position of desperation his clients may be in with this quote:

“If physicians can’t employ physical therapists, nobody can, and they are used in all sorts of medical settings.”

That has to be the craziest argument in favor of physician self-referral yet.  No one can get physical therapist interventions if they are not employed by a doctor?  This assumption of employment visible in the quote underscores the widely held belief that many physicians hold about physical therapists, that they are an auxiliary service rather than an independent medical professional of similar value and capability in the care of musculoskeletal conditions.  Perhaps physical therapists’ fondness for video games assists in perpetuating this belief.

In a stone-cold logical retort, Columbia Physical Therapy’s attorney states his client’s problem with physician self-referral as he describes the practice as having the ability to “create a captive referral market where the referring physician controls both the supply and the demand for patient services.”

Captive markets are dangerous for consumers.  Does that mean that all individuals take advantage?  Not at all.  There are some high-quality physician-owned groups out there.  In fact, I met one last night!  However, the danger lies in the possibility of abuse which is something our health care system should have very little tolerance for.

ERIC

Oh Brother! Still the Wii?

Angry_man
My fear of having non-fitness personnel take up the profession of Wiihab is coming closer to fruition as Nintendo has announced a Fitness package which will include a balance board.  Nintendo itself is spearheading the effort into the fitness industry.

The APTA is very typically all excited about this gimmick and announced their new love affair in this week’s news:

"Look
for an upcoming article in the May issue of
PT Magazine about PTs who have used the Wii as part of
patient care."

How many people in the world can do Wiihab without having to spend time getting a doctoral degree?  Exactly!  So should this be something physical therapists do?  This is very similar to going to see a physical therapist and getting put on an exercise bike for a half hour.  Yes, within our scope of practice, but not good practice.  If I was a patient and hurt my shoulder only to be put on a Wii-regimen…well, I’m not coming back.

I’ve got a bad feeling about this. 
ERIC

Muscle Cramps!

Tetanus
I have a penchant for enjoying things that are often ubiquitous, yet poorly understood.  The human body is ripe with these topics.  Among my favorites are delayed onset muscle soreness, muscle fatigue, and muscle cramps. 

Muscle cramps are often extremely painful and debilitating.  I remember struggling with quadriceps cramps more than one time while cycling.  The worst time was on the return leg of a 80 mile trek through the mountains (relative, I know, but surprisingly steep) of northwest NJ on a hot summer day.  The cramps began at mile 42.  I remember completing the rest of the ride in fear because a feature of muscle cramps poorly appreciated among non-cyclists is that when you do cramp, your foot is mechanically secured to the pedal.  Avoiding a crash and somehow gaining enough control of your tetanic leg to unclip from your pedals is a true miracle!

I enjoyed this recent article in the New York Times, which provides a nice overview of some competing theories behind the daunting muscle cramp.  Featured in the article is one of my colleagues at the Medical College of Georgia, Dr. Michael F. Bergeron, who runs the environmental physiology lab and calls the physical therapy department his home.  He discusses a specific type of cramp related to excessive sweating. 

Dr. Bergeron, incidentally, had an enviable week in the media, also making an appearance in a Times Magazine article, "Little Athletes Big Injuries."

The next time you have a muscle cramp, perhaps thoughts of the scientific wonder that they are will help ease your suffering. 

Yeah, right!

ERIC

The Big Rip-Off

Linking to this NYT’s editorial about the lawsuit between the State of NY and Ingenix seems the thing for PT blogs to do today, so I will not disappoint.

"Mr. Cuomo and the American Medical Association, which has a
long-standing suit filed against Ingenix and various UnitedHealth
companies, claim that the data is manipulated. They claim that health
insurers and Ingenix disproportionately eliminate high charges, thus
skewing the numbers for customary charges downward."

But NPA is a Think Tank, and so linking to this editorial is simply not enough.  We need an original thought on the topic.  Here it is:

Where is the APTA on this lawsuit?  Jump on board with the AMA and, in an act of altruistic cooperation, invoke reform of the slimy health insurance nation that surrounds us.

Am I asking too much?  Maybe.  But I’m please to see this issue getting some press.
ERIC

Physical Therapists Now Eligible for Debt Relief

Last week legislation was approved to finally include physical therapists in the list of health

providers eligible for student loan forgiveness.  

"This amendment provides valuable incentives to enter the profession of
physicalDebt_2 therapy and help meet the high demand for physical therapists
that exists across the nation," said American Physical Therapy
Association (APTA) President R Scott Ward, PT, PhD. "Physical
therapists often begin their careers with significant levels of student
loan debt. Offering forgiveness will help enhance physical therapy
availability for children, adolescents and veterans, and provide
lasting health benefits in these areas."

Indeed!  Physical therapists, does this legislation effect you?  It doesn’t help me, but I am only one.  Check in with a comment!

ERIC

The National Wiihab Crisis

Dunce
Most news articles on physical therapists can be found in newspapers by the following categorization:

"Newspaper name / world news / national news / health news / local news / physical therapy news"

No longer, as I found this headline under the "world news" category in the  Atlanta Journal Constitution:

"Forget rehab, try Nintendo Wiihab"

Yikes!!! World news?  Forget Rehab?  Yes, Wiihab is surely helping our professional branding now, isn’t it?

Let’s put a hypothetical example forward.  I’m a random guy with a business background, perhaps a personal trainer, and a half-dozen Nintendo Wii systems.  I’m not a licensed physical therapist, but still I decide to open a Wiihab Center.  I’m not doing physical therapy, I’m not billing for physical therapy…I’m doing "Wiihab."  Wiihab is exercising with a Wii, surely not the intellectual or professional property of the physical therapy profession.  I’m now free to invite all those injured patients who have read about Wiihab in to exercise at my singlularly branded Wii-clinic.

Is this was all those clinics getting press about Wiihab are hoping for?  Obviously, not.  But as Wiihab gets a national branding and enterprising individuals realize that anyone can open a fitness center, how can they stop it?  Won’t they feel like a dunce when a Wiihab shop opens up next door and bills cash at a higher rate than physical therapy reimbursement for therapeutic exercise!

Will the APTA and state chapters spend thousands of legislative dollars trying to get Wiihab added to practice acts, to prevent chiropractors and athletic trainers from performing Wiihab?  I sure hope not.   

The Wiihab crisis…it could be just the beginning.
ERIC

p.s.  I’ve added a Wiihab category to the blog to track my posts about this next big thing in rehab!

Who Cares About Their Physiotherapist?

Ronaldo
Ronaldo does.  Seen here trying desperately to stabilize his patella after he tore a tendon in his left knee, which has put the career of the soccer star in jeopardy. 

"That will depend not only on the surgery, but also on physical therapy
and the motivation of Ronaldo – currently 31 years old – to return to
high-level sports.” a Paris hospital reported.

Physical Therapy…Paris…not Physiotherapy?  Hmm. 

Am I the only one who wishes American PT’s were called physiotherapists as the rest of the world refers to us/them?  Perhaps having a profession that was it’s own word would reconcile many of the branding and legal problems encountered by naming a profession simply by combining an adjective and a noun that are used 10 million other places in the English language.

Here’s to the American Physiotherapy Association.  (APtA)
ERIC

"Wiihab" Hurts my Brain!

ArtwiirehabapI’m still conflicted about this whole Wii-physical therapy link.  One side of me cringes when the concept of Wiihab has become so pervasive that, indeed, a phrase has been coined.  One side of me asks, "Is it so bad?  Maybe it’s professional insecurity creeping up on me that drives my discontent related to Wii-habilitation?"

I do know that I have almost completely stopped reading my Google News "physical therapy" feed.  It seems like for any 20 articles about physical therapy, 19 of them are about this clinic or that clinic using a Nintendo Wii. 

This is not my first post about the conflict the Wii presents.

I was glad to see Science Blogger, Karen Ventii brings this up on her blog, Science to Life.  She points out the lack of science behind the use of the Wii, and even points us to a pending study on just that topic.  She has a nice video parody of Wiihab linked in as well.

The thing is, I don’t care if there is science that says a Wii produced good results in a physical therapy setting.  I really don’t!  Here is why:

Movement, coordination, muscle control, etc., all combined is not a new concept for physical therapists.  We know how these principles impact healing and outcomes, which is why function and active-based treatments are the hallmarks of physical therapist treatments.  Exercise with a Wii, my friends, will only ever be functional for helping people to play the Wii. 

If you, as a patient, suffer from such disinterest in your health and how your body works that you need a toy to provoke interest in healing, I say, "Shame on you!"

And will all those articles on Wiihab please also mention two things:  1)  The clinic in this article is looking for gimmicky, cheap press, and, 2) physical therapists (good ones, at least) do not provide painful, dreadful treatments that are so awful as to require a parlor trick to enable a patient’s endurance of said treatments!

Come on, Wiihab providers!  Are you physical therapists, medical professionals with a doctorate-level education and significant musculoskeletal expertise, or are you a sideshow performer interested in games and cheap thrills?  I guess it depends on whether you give out stuffed animals to patients who beat the video games prior to discharge!

I guess I’m less conflicted than I thought on this…

ERIC

Not Just Clothes, Performance Enhancing Clothes

Phelpsspeedo

FanHouse checks in with this little bit about the fancy new swimsuits to be worn in the upcoming Olympics, and how Michael Phelps describes them as the best swimsuit ever made.

“It literally feels like you are a rocket coming off the wall,” said Phelps.

This makes me think of poor Oscar Pistorius.  At what point does technological clothing provide enough of a competitive advantage to warrant it an "unfair advantage" that Pistorius is proposed to have? 

I know, many countries will have access to the suits, which is different from a double amputee except for the most dedicated of competitors.  If running on prostheses was such an advantage, why doesn’t every sprinter have a surgeon and a stump wrapper in their contact list?

But just because everyone has the suit, it still  raises a question of competition.  Perhaps the swim suit could also come with flippers.  Should all the marathon runners ride motorcycles this summer?

It might not be a bad idea considering the expected air quality in China!

ERIC

Article Chronicles Poor State of Business for PT's

I can’t believe I read this in the actual news…one not written or published by a PT, that is.

"At least 10 outpatient physical therapy clinics across Southwest
Florida have closed since midsummer as a trio of trends has sapped the
businesses’ income."

The article goes on to give an excellent summary of the state of the PT union, including some notes on big mergers, Stark laws, Medicare caps, and the works. 

"If you’re going to do things the right way, what is best for the
patients and the ethical way, you’re going to lose a lot of money,"
said Karen Fitzpatrick, account Specialist for Bay Area Physical Therapy & Wellness.

The APTA even makes a slightly weak appearance as physician self-referral is discussed.

ERIC