Happy Mother’s Day: Get Real

[icon style=”notice”]Update: Be patient with the Samahope.org site as they roll out over the next few days… [/icon]

Welcome to PT Think Tank’s new website design and Happy Mother’s Day to all the mom’s out there!

Today, we’re going to jump right in and get real on Mother’s Day. So real, in fact, that we’re going to talk about fistulas. Obstetric fistulas, to be specific. The kind that form mostly in impoverished countries after childbirth, we’re birth trauma causes tissue death and connects parts of the mother’s pelvic anatomy that should never, ever be connected.  Women suffering with obstetric fistulae are ostracized by husbands and communities and suffer from infections, poor quality of life, and even death.

According to The Fistula Foundation, the occurence of new obstetric fistulae number about 50,000-100,000 annually, while the global capacity to treat this condition is only around 20,000. While this condition is extremely rare in developed countries, the World Health Organization estimates that between 2 to 3 million mothers in poor countries struggle with it. While the cause of obstetric fistulae are complex,  with as little as $450-$1000, the condition can be effectively repaired surgically.

My very compassionate and talented fried, Michelle Greer let me know about Samahope. Samahope.org is attempting to tackle this problem. This new venture is working to crowd-fund this procedure for women who can’t afford it. In an elegant interplay between philanthropy and technology, Samahope.org allows donors to select the individuals you want to help, donate simply using PayPal, and even track the outcomes for the surgeries they helped fund. Samahope.org is a project of Samasource.org, a non-profit based out of Silicon Valley who is working to reduce poverty through creating jobs via the innovate idea of mircrowork, connecting people with jobs over the internet. Leila Janah, the founder of Samasource, spoke recently at a TED event in Brussels:

[youtube id=”319sQ9s-lyQ#!” width=”550″ height=”300″ align=”center”]

Get involved and for this Mother’s Day, in addition to that nice pot of flowers and brunch we all like to confer upon our maternals, give the gift of life. Samahope.org is beginning their rollout today. In fact, they have but one tweet. It says, “How can you help change a life with only $20? Easy… I just did.

[button style=”green” link=”http://www.samahope.org/donate.php” target=”_self” align=”left”]Donate Now[/button]

 

The Value of a Patient Portal: Increasing Compliance While Reducing Cost

As patients become more and more interested in engaging and communicating with their healthcare providers online, the demand for portal applications will only increase. Patients are looking for innovative ways to access their health information and care providers – what better way than online patient portals?

Portals are healthcare related online applications that allow patients to interact with their healthcare providers through secure websites or integrated electronic medical records (EMRs). These applications can give patients the ability to request prescription refills, make appointments, receive medical reminders, view billing statements, and ask providers questions about ongoing treatment regimens (2). The key is engagement and it’s a growing trend among individuals who expect the most out of their provider‐patient relationships.

While portals empower patients to take control of their treatment and recovery, they hold even greater potential for healthcare providers. In particular, these platforms can substantially enhance the quality of physical therapy care. Compliance is an overarching issue for ensuring proper recovery during the physical rehabilitative process. Think home exercise regimens, post‐surgical contraindications, body mechanics… physical therapists always have so much to communicate and monitor. As we discussed in past blogs, compliance plays a direct role in patient outcomes. Portals provide a secure platform for sending important messages directly to patients and monitoring their compliance at the clinic and outside of it. The downstream effects are increased efficiency and productivity, reduction in administrative overhead costs and improved patient outcomes. These applications also allow therapists to expand their practices’ reach by providing innovative solutions for patients that are geographically inaccessible.

So, you may well ask: is now really the time to integrate this type of technology in my practice? In a recent survey conducted by Intuit Health, 73% of respondents said that they would use an online communication application to pay medical bills, communicate with their physician or physician office, make appointments and view lab results (1). More than 40% said they would consider switching physicians in order to obtain such access. Research such as this makes it clear that patients are eager to adopt such applications and now is the time for providers to get on board.

The use of portal technology is inevitable as patients take control of their health and demand two‐way communication platforms from their providers. As we innovate around ways to increase the quality of care provided to patients, the integration of secure portals should become a mainstay for effective clinical practice.

Resources

1. Shinkman, R. 2011. Americans want more online access to physicians, FierceHealthIT, http://www.fiercehealthit.com/story/americans‐want‐more‐online‐access‐physicians/2011‐03‐07.

2. Terry, K. 2011. Patient portal use becoming an inevitability, ForceHealthIT, http://www.fiercehealthit.com/story/patient‐portal‐use‐becoming‐inevitability/2011‐04‐23.

This guest post was co‐authored by Bronwyn Spira, P.T., President of Force Therapeutics and Mark Anthony Fields, Ph.D., M.P.H, Digital Media Associate of Force Therapeutics. Force Therapeutics is an online suite of solutions tailored for the busy physical therapist. Force Therapeutics can be found at www.forcetherapeutics.com, www.facebook.com/forcetherapeutics, or www.twitter.com/ForceTherEx.

The AB783 Story Continues

PT in Motion News Now now alerted me that AB783 has been re-scheduled for hearing on Monday June 27th. This bill will be heard in the California Senate Standing Committee on Business, Professions, and Economic Development.

The drama surrounding AB783 has taken some interesting turns over the past few weeks.

  • June 13th: AB783 fails to pass out of committee with 3 yes votes, 2 NO votes, and 4 abstains
  • June 20th: Mary Hayashi pulls the bill from reconsideration. Oddly, she states she would like to meet to work something out with the California Chapter of the American Physical Therapy Association [Rumor has it this never happened]
  • June 27th: AB783 is again slated for reconsideration. If it fails to pass out committee AGAIN, it can can not be re-heard until 2012 [which if history is any indication, it will be back]

Luckily, NBC LA continues to provide top notch coverage and analysis of the issues in their THIRD article entitled Caution: State Laws Hazardous to Your Health. In the comments section Johnny Chen makes a great point:

There is a reason why doctors are not allowed to own pharmacy clinics/establishments. It’s called conflict of interest. The same should apply to physical therapy clinics. Hayashi should be ashamed of herself — why would she support a bill that takes the power out of the consumer’s hand and costs taxpayers/health care system.

Unfortunately, there is a very, very easy cure to this legislation and ongoing POPTS battle:

Physical therapists need to stop working for Physician Owned Physical Therapy Clinics.

Remember the Stop POPTS Campaign has a website, Twitter, Facebook, and You Tube Channel. Read, follow, friend, and watch! Then spread the word.

Also, please take a few moments to read the 3 NBC LA Articles and leave your comments + feedback.

  1. Physician Run Physical Therapy Clinics Scrutinized
  2. Physical Therapy Bill Delayed
  3. Caution: State Laws Hazardous to Your Health

The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is.                            –Winston Churchill

The ‘continuity of care’ argument is dead. It is hard for me to get a hold of a physician when I page them in a hospital, or call them from the private physical therapy practice I practice within. They are busy. We are busy.

The issues surround physician employment, and ownership, of physical therapists are fairly simple: conflict of interest and referral for profit. What makes legislators, payors, and the public believe this will improve communication, care, and patient outcomes?

The American Physical Therapy Association doesn’t support it. The American Academy of Orthopaedic Manual Physical Therapists doesn’t support it. In fact, the American Medical Association ethics committee doesn’t support it.

The data doesn’t support it. Human behavior and psychology research don’t support it. Logic doesn’t support it. Ethics doesn’t support it.

Dear Assemblywoman Hayashi: Physical Therapists, data, logic, ethics, and human behavior all say NO! This is a bad idea!

But, physicians support it and say it is best, so it must be true…right?

AB783 and the California Campaign to STOP POPTS

On Monday, June 13th California Assembly Bill AB783 failed to pass out of committee in the California Legislature. The bill, which would explicitly allow physicians to employ physical therapists, would have been in stark contrast to current State of California Legislative Counsel opinion which states that it is illegal for physical therapists to be employed by physicians.  The bill has been pushed by Mary Hayashi, who not surprisingly receives quite a bit of campaign money from physician groups.

Recently, the issue has received increased attention as physical therapists and activists have taken to twitter and facebook to spread the word. Even more impressive, NBC LA has now run two articles critiquing the bill: Doctor Run Physical Therapy Clinics Scrutinized and Physical Therapy Bill Delayed.

Some sources have reported that supporters of AB783 have spent upwards of 2 million dollars while physical therapists and the CA Private Practice Section have spent a mere 57 thousand dollars. I think the relative success of the PT campaign illustrates the importance of viral, social medial in the form of Facebook, Twitter, and an online presence. Most notable is the Stop POPTS campaign which I have written about previously in the post Anti-POPTS Movement goes Web 2.0. But, even the California Private Practice Section has been slamming their website with information and announcements

But, in the end, I think it also illustrates the fact that the bill is grossly illogical as it promotes a huge conflict of interest in medicine: referral for profit. I wrote an extensive piece about a year ago on conflict of interest and POPTS which can be found on the AAOMPT Student Special Interest Group Blog.

Interestingly, the Medical Code of Ethics States:

“[u]nder no circumstances may physicians place their own financial interests above the welfare of their patients.”

And, what about The American Medical Association (AMA) Council on Ethics and Judicial Affairs (CEJA)?

“physicians should not refer patients to a health care facility which is outside their office practice and at which they do not directly provide care or services when they have an investment interest in that facility.”

Please, take a few minutes to read the articles. Then comment and share. Tweeps on twitter are using the hashtags #StopPOPTS  and #VoteNoOnAB783. The more physical therapists continue to articulate the many problems with referral for profit and physician employment/ownership of physical therapy the more press it will receive. Both articles have already received countless comments from individuals regarding the problem with POPTS.

What are you waiting for?

  1. Doctor Run Physical Therapy Clinics Scrutinized
  2. Physical Therapy Bill Delayed

The continued success of the anti-POPTS movement hinges on involvement from the bottom up. Every comment, like, tweet, and shared link are useful. Every mention in conversations with patients and the public add up. A big thank you to all the physical therapists who have gone to capitol to meet with legislators and testify. And of course, the importance of  the California Private Practice Section and California Section of the APTA can not be underestimated.

Continue to spread the word!

It’s Not About the Patient

If you have not yet viewed this video from Jack Bert, MD, from which the above screen shot was taken, please check it out now. Brace yourself. At the 8-minute mark, he discusses PT. He gets excited that a physician in SC was able to hire a chiropractor and “athletic trainers to do the PT” and bill for it, and ran 60% of the physical therapy business out of town.

Is there not some really big problem with this situation? Does this not border on breaking the law? The unrestricted medical license of physicians allows them to bill for whatever medical service they want. Thus, the athletic trainers can indirectly become physical therapists. As a licensed physical therapist in the state of SC, I wonder why I’m paying a fee for licensure, when the state could simultaneously allow non-licensed individuals to perform the service that I’m trained to provide. Why are consumers not being protected from this action?

In the comments on the site, which by now are littered with offended physical therapists, Jack Bert responds:

“Now that I have thought about this, the discussion on ancillary services really has nothing to do with physician arrogance or greed. It really has to do with what is best for the patient.”

I simply don’t buy it. How is having patients be treated by providers with less training and a different skill-set than PT’s (the athletic trainers) equate to something better for the patient. Yes, physicians do medicine. They do it well. Physical therapists, well we do rehab and do it well. Can’t we both exist together?

He goes on to suggest:

“For ancillary providers, such as physical therapists and chiropractors, to believe that they have the same training and ability to diagnose musculoskeletal pathology as a boarded orthopedist with a minimum of 5 years of post-medical school training, excluding a fellowship, is truly astounding.”

Perhaps Jack Bert is not aware of the body of research that suggests overall, that physicians are not adequately trained in musculoskeletal care either. In fact, I find it astounding that a general practitioner with little specific training on the subject finds themselves capable of diagnosing the specifics of an injured shoulder or neck. I fully agree that Jack Bert, a board certified, fellowship trained, orthopaedic surgeon has very capable musculoskeletal examination skills, but I also feel that his disregard of physical therapists to also have those skills offensive and reflective of an old-school physician mentality whose time has passed. There is research to support my claim. Physical therapists are musculoskeletal experts!

If this was truly about the patient, we would give the patients choices. We would empower them to choose their providers. We would act to reduce limited providers and wait times and work towards an equitable distribution of resources. There’s enough demand for everyone to play together. Comments like those of Jack Bert simply shed light on what these turf battles over physician-owned PT services and direct access restrictions are really about. It certainly isn’t about the patient.

Physician Owned Physical Therapy Services (POPTS) in California. The anti-POPTS movement goes Web 2.0

Physical Therapists in California are taking to all forms of the web and utilizing Web 2.o Principles to oppose recent efforts by the California Medical Association and Legislator Mary Hayashi to LEGALIZE Physician Owned Physical Therapy Services in California through AB783. This bill would provide explicit language legalizing the employment of physical therapists by physicians. Those who have followed the POPTS debate in California are left scratching their heads because…

Interestingly, the State of California Legislative Counsel recently rendered an opinion on September 29, 2010 that it is illegal for PTs to be employed by any professional corporation except for those owned by physical therapists. The California Physical Therapy Association provides details

The opinion from Legislative Counsel confirms that, because the California Corporations Code does not specifically include physical therapists on the list of those who may be employed by a medical corporation, a physical therapist is prohibited from providing physical therapy services as an employee of a medical corporation and may be subject to discipline by the Physical Therapy Board of California for doing so.

Now in response to this new, proposed legislation the California Physical Therapy Association released an electronic memo opposing the new bill.

But, a group of concerned consumers (and I am assuming physical therapists) has leveraged technology and taken the movement to a whole new level. They have crated a campaign entitled “Stop POPTS.” So, what Web 2.0 tools are they utilizing? Well here is the list:

But, wait, that is not all! They have also created a Stop POPTS iPetition which currently has over 880 electronic signatures. They were able to amass over 500 within the first 24 hours of creation!

While it is important for our professional organizations to disseminiate opinions, information, and press releases on the national, state, and local level I am always left wondering: Are they effective? Do they even reach, and more importantly affect, the target audiences: the public, legislators, and other health care professionals? Now, the California Medical Association has been able to provide some information through news paper articles and other publicity. Unfortunately, they are able to use their clout as physicians in such outlets, and Joe Public will likely accept what they present at face value (with little questioning or skepticism). Which is a point we sometimes miss. Yes, it is important to spread this information to our PT colleagues, but we need to be reaching the public, legislators, and other health care professionals. Patients, small business owners, and legislators should be outraged! And WE need to light that fire.

Maybe the APTA, the CPTA, AAOMPT, and other organizations should take notes from the Stop POPTS Campaign in California. They are leveraging the web and technology to spread this information virally and aggressively. I believe such an approach is more effective. So, if you support the profession of physical therapy and oppose POPTS please spread the word via facebook, twitter, you tube, and even sign the petition! The Stop POPTS website has an abundance of great information.

Want more Information about POPTS?

Tim Richardson of the blog Physical Therapy Diagnosis recently wrote a post entitled Is Physical Therapy in California a Zero Sum Game?

Last year I authored a long post about POPTS and Referral for Profit on the AAOMPT Student Special Interest Group Blog detailing current rulings in Washington State as well as providing links and information about Stark Laws. The post has a TON of links to other information including APTA press releases and the American Academy of Orthopaedic Surgeons (misguided) view points.

What’s your story and opinion about POPTS? How do we spread it? Can we empower patients to tell their stories?

Healthy People 2020: Physical Therapists in Health and Wellness

CSM kicked off with a talk about how physical therapist’s can fit into the Healthy People 2020 initiative . Further, the roles and potential roles of physical therapists in health, wellness, health promotion, and public health.

  • Work towards health focused practices
  • Health as an outcome
  • Physical Therapy is about movement and function
  • Address societal needs of movement, function, living with disability, and health/wellness
  • Ethics > Meet the health needs of people locally, nationally, and globally
  • Link to our work to individual patient’s, societal needs, overall healthcare
  • How to obtain reimbursement for preventive care?

The speakers gave broad information about health promotion and physical therapists. Each gave some interesting case examples. Each advocated for physical therapy in serving the societal needs of not only health, but living with disability. I absolutely agree! But…

Especially in private practice how do we not only incorporate health promotion, but make it fiscally sustainable and or profitable? Sometimes it is difficult enough to obtain reimbursement and or private pay for a current condition let alone chronic health conditions such as hypertension control, obesity, healthy exercise habits, and smoking cessation. But, on the other hand, the personal fitness and health industry (i.e. weekend trained personal trainers at 24 hour fitness) is booming. How can PT’s obtain a slice (or a big chunk) of this market?

I think they speakers brought a good point that we need a critical mass of not just PT’s, but legislators, public policy makers, patients, and other healthcare professionals committed to societal health in various practice settings. And a recognition of rehabilitation and physical therapy as essential parts of not only health care, but health promotion.

Why aren’t we moving in that direction? Do we all need to broaden our view of our professional role? What is the SWOT [Strengths, Weakness, Opportunities, and Threats] Analysis of the PT profession, and each us as individual practitioners, in regards to health?  I think there are a lot of opportunities, but many, many barriers.

Do we have what it takes to step up to the plate? Or, at least get a place at the table?

  • How do we measure health and outcomes related to health?
  • How do we market and spread the word to: patients, physicians, legislators, payors (ha!), the media, educators, public health professionals, and thus society?
  • What role does technology play in our promotion of health and wellness?
  • Can we leverage technology to achieve and spread the above goals and ideas?

I think the first talk brought up many, many questions, problems, and ideas…

Sickening Report from WSJ

Spine Surgery Greed

Already controversial, yet continually growing more common, instrumented spinal fusion surgery took a public relations hit in an article in today’s Wall Street Journal. “Top Spine Surgeons Reap Royalites, Medicare Bounty” is an excellent, if not disheartening piece of investigative health journalism.

This piece is a must read for anyone involved in the care of patients with back pain, anyone with back pain, and hopefully, anyone involved in health policy that can help. Senator Grassley, You read this, right?

“One surgeon at a hospital in the Midwest disclosed receiving between $400,000 and $1.3 million in royalty, consulting and other payments from three spine-device makers. Using the Medicare-claims database, the Journal found this surgeon performed 276 spinal fusions on Medicare patients in 2008, by far the most of any surgeon in the country.”

“At least my spine is aligned now…”

Comfortably Bad Medical Beliefs

http://www.flickr.com/photos/evilerin/3353917569/These were the words of a friend who had just been to see a chiropractor for her sore back. I had treated her back the day before and had asked how it felt. The response was, “Well, I went to see a chiropractor today and it’s still really sore, but at least my spine is aligned now.”

While experiencing the obvious professional snub, the part of the statement I took exception to was the “aligned” part. I could tell she had taken comfort in the fact that no matter how her back felt, the chiropractor had “fixed” the alignment and she was on her way to better health. The only problem is, the explanation she was given as justification for the treatment doesn’t make any sense.

The theory of vertebral subluxation, first introduced as a medical theory in the 1800’s, has never been shown to be a valid theory. In fact, chiropractors themselves have issued loud warnings about threats to public health that come from relying on the concept that the spine can be misaligned and needs to be “adjusted” via spinal manipulation. Here’s a research article published by chiropractors which concludes:

“No supportive evidence is found for the chiropractic subluxation being associated with any disease process or of creating suboptimal health conditions requiring intervention. Regardless of popular appeal, this leaves the subluxation construct in the realm of unsupported speculation. This lack of supportive evidence suggests the subluxation construct has no valid clinical applicability.”

But still, people take comfort when they hear a theory that makes sense to them. In these instances, the comfort of the explanation can be so powerful that it causes the person to disregard facts to the contrary. There is also a public education problem here in the case of back pain and spinal alignment. It’s a particularly interesting dilemma, in that spinal manipulation is very effective for low back pain, just not for the reasons most chiropractors purport. This perpetuation of back medical theory is a real problem as we work to help patients make smart, cost-effective choice in the face of limited resources.

The Irrational Mind of Public Health

In an excellent piece of science writing by Christie Aschwandan, entitled, “Convincing the Public to Accept New Medical Guidelines,” this interplay between strongly held beliefs and public health data is explored. Runners who take ibuprofen, the controversial new mammography guidelines, and invasive and expensive imaging for low back pain are all discussed as examples of where beliefs and data are in conflict.

“But when facts contradict a strongly held belief, they’re unlikely to be accepted without a fight. “If a researcher produces a finding that confirms what I already believe, then of course it’s correct,” MacCoun says. “Conversely, when we encounter a finding we don’t like, we have a need to explain it away.””

Such is the case with many things in life. It is easier for us to believe something that makes sense. It’s more comforting to take action. Thus, when the best course of action for back pain is to wait it out, stay active, and not to get an MRI, it feels like the wrong decision. This has as much to do with the way our minds process information as anything.

“There’s this common assumption that we’re just going to educate people about the facts, and then they’re going to make use of them,” says Brendan Nyhan, a health policy researcher and political scientist at the University of Michigan. “But that’s not how people process information — they process it through their existing beliefs, and it’s hard to override those beliefs.”

What this all translates to is the need for researchers, public health officials, and health providers to improve the way new information is communicated to the public. I guess we should include the media in that as well! As Aschwandan concludes, “Explanations that offer hope and empowerment will always hold more appeal than those that offer uncertainty or bad news, and when new evidence offers messy truths, they must be framed in a positive light if they’re to gain traction. You can ask doctors to give up ineffective interventions, but you must never ask them or their patients to abandon hope.”

How true. Except often, it’s hard to know where to start.

Can You Write?

US_Capitol_Building_at_night_Jan_2006We know the world is all about Healthcare reform right now…well a lot of it is. I saw that Congress received 150,000 phone calls in one day!

Well, if you don’t feel like calling and can’t get to Capitol Hill for a visit, try writing a letter! Check out this extremely detailed post about writing letters on the AAOMPT Student Special Interest Group blog.