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Those of you who regularly read my blog and know me at all, are probably very aware of my distaste for pharmaceutical companies and their perpetual courtship of physicians.

Here is an article that has some solid numbers behind it, including a couple instances of doctors receiving money from a drug company AND making guidelines for other doctors to follow that includes the drug they are being paid to promote!

Did you hear that? A doctor may make guidelines for how much and often a kidney patient receives a cholesterol medication even while being paid by the manufacturer of that medication. Outrageous!

How, in light of this conflict of interest, are we to trust any formal guidelines at all?

Does anyone else see a problem with this? This guy from Harvard does:

Labels: health policy, physical therapy, Science Literacy

A series of blog posts led me to MedInnovationBlog, where I read a post: On Physical Therapists and Keeping Patients Moving.

That was nice to see and read about. Then came the comments. Physiatrists, upset that one could write about the profession of Physical Therapy and not give them credit. The blog author seemed pathetically apologetic in his response, and even went so far as to quickly credit Physiatrists for helping train Physical Therapists. Some clarification is needed.

The history of both Physiatry and Physical Therapy have very closely knit roots. In reviewing several sources of historical information on these professions, I find it interesting that neither mentions the other. Odd, because careful reading of these histories suggest each profession arose out of the same need and then developed independently.

Both professions start out with claiming roots to Hippocrates and the such….but let’s start at a more realistic date: World War I and 1917.

The Army, trying to deal with many injured soldiers, commissioned two physicians to create the Division of Physical Reconstruction upon recommendation from the Division of Orthopedic Surgery. The two physicians, Frank Granger, MD, and Joel Goldthwait, MD, signed on two Reconstruction Aides (read: Physical Therapists) who had already been trained and were helping patients with polio in Europe and the U.S. with rehabilitative modalities. They were Marguerite Sanderson and Mary McMillan. All four of these individuals eventually became influential in the founding and growth of the two professions in question. Each profession initially faced a struggle to become an accepted part of the current medical establishment.

Today, the two professions are largely separate, with unique educational programs and autonomy. The growing knowledge base of one is interdependent upon the other and each must yield respect accordingly. In my daily routine, I use the professional journals of each equally.

There is, however, one significant change upon us. For the first time, Physical Therapists are not dependent upon physicians for prescriptions, diagnoses, or treatment plans and are being educated to the doctorate level. It will be interesting to see how the relationship between these two mutually beneficial professions will continue to evolve in light of these changes.

Labels: physical therapy

Labels: back pain, health tools, physical therapy

A pound of body fat (see image) equates to approximately 3500 calories. So a calorie deficit of 500 calories (meaning that you burn 500 calories more than you eat each day) you would lose approximately one pound per week:

Labels: health tools, misc., physical therapy

For those of my readers who work in the medical field, perhaps the title of this post caused a slight shudder or tingling in the spine. Understandable, indeed, as we have become accustomed to health insurers devising ways to reduce payments under the guise of improved quality of care. But, as a provider interested in improving my performance and having “Quality” be a marketable part of my services, I can see potential value in the concept.

For those who have never heard of Pay 4 Performance, an quick overview is indicated:

Insurance companies, Medicare included, are developing systems of payment for medical services based on performance, or quality. For example, a Physical Therapist that reports the risk of falls for each patient would be eligible for improved reimbursement. A physician who screens for cervical cancer would benefit likewise.

A good overview is available via this article, last week in The LA Times. It talks about a state-wide pilot program in California. California is the state where managed care and HMO’s came from too.

While improving healthcare quality is a vitally important part of reform, healthcare providers are nervous that these initiatives will become mandated before the details are worked out.

Details like:

• Currently, there is no agreed upon measures of what “Quality” practice consists of.
• Physical Therapists worry about measures having anything to do with PT at all, instead just being a poorly translated medical-based measure.
• How will the system compensate for those times when quality measures don’t make sense i.e. measuring for fall risk in a bed-bound or wheelchair bound patient.
• The list of concerns goes on.

In short, this change is coming, but everyone in concerned that it might just be more hoops to jump through to get paid, and that healthcare quality will not improve because of it. Careful planning is needed if quality is to improve. Either way, the insurance companies are gaining a tool to withhold more payments, and presumably, increase their bottom line. Personally, I hope it works out…maybe we could weed some of the detractors of quality out of our profession.

Here are some links:

Health Provider Report Card

Board of Directors of IHA, a leading institution behind this measure (note insurance bias of board)

Wikipedia Explanation

Medicare Page

Labels: health policy, physical therapy, Science Literacy

Ahh, Blue-Footed Boobies!

One of my favorite authors, Kurt Vonnegut, wrote about Huntington’s Disease in the great book, Galapagos. The main character’s pending and inevitable onset of neurological wasting intrigued me. I tried to imagine what that must be like.

Since Mr. Vonnegut wrote that book, researchers have identified the gene in question that causes this disorder, and tests are now available for only a couple hundred dollars for people who are at risk. Today’s New York Times, had an excellent piece on Huntington’s Disease, Facing Life With a Lethal Gene.

I no longer have to imagine what it must be like to have it. The article really lays it out with the story of Ms. Moser, a young Occupational Therapist who carries the gene.

To circle this wagon back around, tonight, the National Geographic Channel is having a special called, Galapagos, “It’s like no where else.”

So what am I really talking about here? Evolution. It’s everywhere!

Labels: current press, evolution

The tag-lines went something like this: “Watch NBC tonight and find out why the way we do CPR has changed.” So I then changed the channel, only to find the same teaser on another station. By the end of this week’s news cycle, an unassuming viewer could be convinced not to perform rescue breaths as part of CPR.

I’m sure you know what I’m talking about, a new study released this week in The Lancet, a well respected peer-reviewed journal. In observing survival rates of over 4000 individuals, it found no benefit to those receiving both breaths and compressions. In fact 22% of those without rescue breaths survived, while only 10% with rescue breaths survived. Time to jump on a single study bandwagon???

Not yet:

1. The study looked at older CPR guidelines (15:2), not the current 30 compressions to 2 breaths.
2. The study only looked at cardiac-related cardiac arrest. Non-cardiac causes of arrest include drowning, trauma, choking.
3. The study only looked at adults, who have much less sensitivity to lack of Oxygen than do children.

And this is why, despite presumably hundreds of calls from the media, The American Heart Association has decided not to change its CPR Guidelines.

News Watcher Beware!

Labels: current press, health policy

So, in my prolific web/headline surfing I have become fond of, I often find myself viewing items I wouldn’t have expected. Today, I was reading through hundreds of reader-entered Haiku poems for a contest. The poems are for, and supposed to be about, Font. Typeset. For a dictionary. The Helvetica documentary to be specific.

Most were like this (by Dan):

About mid-way down the list I found this (by Sean):

Labels: misc.

Well, I’m done with my rant for the day. A change of pace is needed. Here is a very cool new type of spinal implant to check out: http://www.impliant.com/

It’s like an existing Lumbar Disk Replacement product, but mutli-level and the website has some very trendy videos!

On a roll? Check out this professor at Yale, a disc replacement geek!

Labels: back pain, physical therapy

In the past week, I’ve noticed two different reports of instances where an individual has defrauded Medicare for millions of dollars through billing for Physical Therapy Services.

This guy in Trenton, NJ.

And this guy in Detroit.

Now, according to reports, the prevalence of this crime is growing. But what does Medicare know about opporunities for fraud within its system?

An Example: In May 2006, a report was issued by the The Department of Health and Human Services, Office of Inspector General regarding Medicare Billing for Physical Therapy by Physicians and the “incident to” rule.

Here are some excerpts from that report:

• “Physical therapy billed directly by physicians represented approximately $158 million out of a total of approximately $528 million for physical therapy claims billed to the Part B carriers and allowed by Medicare in the first 6 months of 2002. Medicare allows physicians to submit claims for physical therapy that they do not perform personally, as long as the services are an “integral, although incidental, part of the physicians’ personal professional services in the course of diagnosis or treatment of an injury or illness.”2 The total allowed for physicians’ physical therapy claims has increased from $353 million in 2002 to $509 million in 2004, and the number of physicians who billed for more than $1 million in physical therapy has more than doubled, from 15 to 38 in the same 2-year period.”

• “Under the “incident to” rule, licensed physical therapists need not perform the services, and Medicare currently does not require licensure or certification of staff that perform “incident to” physical therapy. However, in all other settings…Medicare requires that only licensed physical therapists can render physical therapy.”

• “78 percent of physical therapy rendered in physicians’ offices did not represent true physical therapy”

• “Ninety-one percent of physical therapy billed by physicians and allowed by Medicare during the first 6 months of 2002 did not meet program requirements, resulting in $136 million in improper payments.”

• “Because of inadequate documentation, reviewers had difficulty assessing the quality of the therapy services.”

• “One beneficiary in our sample received 15 months of physical therapy for lumbago and osteoarthritis, for which Medicare allowed $39,126. The beneficiary’s physician did not document a plan of care and did not establish medical necessity for the services. The physician, a general practitioner, billed physical therapy to Medicare for 672 patients in 2002, an average of 27 patients per day. In 2002, Medicare allowed $752,531 for this physician’s physical therapy claims.”

WOW!

And, the report’s conclusions and recommendations:

“…we have decided not to issue a report that would include formal recommendations to CMS. Instead, we are transmitting this summary of our review in the event that the information will be useful CMS’ s review of the physical therapy benefit and future considerations of the “incident to” rule.”

Translation: They did NOTHING!

If Medicare doesn’t act to reduce the opportunity for fraudulent billing, how can they ever expect not to have fraudulent billing. Granted, the instances in the news were not physicians, but the point of bringing up this report was to highlight the number and type of loopholes in this system that go unchecked. If you want to attract a mouse, put out some cheese!

I am glad they caught these criminals, however.

Labels: current press, health policy, physical therapy