Not all patients get the same treatment for pain because not all therapists have the same knowledge

“Exponential increases in magnetic resonance imaging (MRI) scanning to identify these damaged structures (believed to be causing low back pain) have led to escalating rates of spinal fusions and disc replacements.”

There is a trend towards increased surgery rates in the US for low back pain.  We see upwards of a 777% increase in spine surgery for low back pain.  The sad part is that the your chance of having surgery is more dependent on your geographic location than other variables.  It has been said that if you are trying to avoid a surgery that you should also avoid an MRI…which takes us to the next fact.

“…evidence that abnormal MRI findings are prevalent in asymptomatic populations and are poor predictors of future LBP (low back pain) and disability”

In other words, if you go looking for a problem…you’re likely to find one.  The “problem” on the MRI may not actually be causing your symptoms though, as we see “problems” with people that have no symptoms.  To put it another way, if a “herniated disc” was always a cause of pain, then everyone with a herniated disc will have pain.  We know that this isn’t true.  This indicates that the structure/tissue that is a “problem” on the MRI may not be causing any problems at all during your day.

“…providing a patient with a pathoanatomical diagnosis can result in increased fear and iatrogenic disability”

Lots of big words there, so let’s work through this together.

Patho: bad

Anatomical: body parts

Therefore: pathoanatomical = bad body parts

This is typically what you hear when you have imaging (MRI, X-ray, CT scan) performed.  Herniated disc, degenerative joint, arthritis, stenosis. All of these words mean that something abnormal was seen on the image.

Iatro: means relating to medical treatment

Genic: means coming from

This means that the “iatrogenic disability” could be disability coming from medical treatment.

I know what you’re asking: “How can the medical interaction with a doctor/therapist/medical professional be causing the disability?”

This is a great question that the authors of the article will go into in a short while. More to come.

“It is increasingly clear that persistent and disabling LBP is not an accurate measure of local tissue pathology or damage alone…it is best seen as a protective mechanism produced by the neuro-immune-endocrine systems in response to the individual’s perceived level of danger, threat or disruption to homeostasis.”

WHAAAT?!

This means that the tissue that was previously damaged may not be the culprit for prolonged pain.  For instance, your body can have a protective mechanism produced by the brain when it feels threatened.  The brain is powerful in creating change. For instance, watch this video to see how quickly it can start to change.

“…pain and behavioral responses may fluctuate based on a person’s perception of threat, levels of attention to pain, mood, contextual social stressors, sleep, and activity levels.”

If you feel threatened, your pain levels may increase.  Removing threat through distraction has been shown to be helpful in multiple studies.  Tetris seems to be one of the most studied games.  Also, math is more painful to some than others.  In the clinic, I have used math as a distraction and watched how pain rapidly resolves and some patients are able to perform movements that they wouldn’t consider performing if they weren’t distracted.  There is some thoughts that the more often we ask you about pain…the worse it actually gets because we force the patient to emphasize the feelings of pain compared to their current function.  Finally, we know that a lack of sleep can cause a myriad of problems from difficulty concentrating to an increase in pain due to increased nerve sensitivity.  These are all factors that play a role when a patient comes to the clinic experiencing pain.

“This contemporary understanding demands a shift away from providing a simplistic structural and/or biomechanical diagnosis and treatment for LBP…enables the patient to become a partner in a therapeutic journey”

For some patients, we can correlate a “problem” on the MRI with their symptoms, but in a subgroup of patients, we are unable to do this.  For that subgroup, we need to look past the pathoanatomical model and therapeutic alliance (the teamwork between the therapist and patient) becomes very important in order to empower the patient with regards to symptom response and education.

“Growing evidence suggests that current practice is discordant with contemporary evidence, and is in fact often exacerbating the problem.”

We may not need to abandon the patho model completely, but we as practitioners need to have more than just the patho model.  In order to prevent iatrogenic pain beliefs, we need to grow our skills in order to better help you…the patient.  If you are going to therapy and are not seeing relief within 6 visits and don’t feel that your therapist has a strong understanding of your pain…seek a second opinion. Not all Medical Doctors are the same, and the same can be said for physical therapists.

Excerpts taken from

O’Sullivan P, Caneiro JP, O’Keefe M, O’Sullivan K. Viewpoint: Unraveling the complexity of low back pain. J Orthop Sports Phys Ther. 2016;46(11):932-937.

 

 

Not knowing versus not learning

“Ignorance: a limited understanding of all the relevant physical laws and conditions that apply to any given problem or circumstance”

I don’t think that this is much of a problem in the physical therapy profession for the basic concepts of the profession.  The issue of ignorance comes into play when we start discussing current evidence.  A new graduate’s primary responsibility is to pass the boards ( a national test in order to determine basic competency in order to practice as a PT).  Unfortunately, the boards are based off the books used during the physical therapy program and the books are based from research that is at least 5 years old or older.  This means that the students are being tested on material that is greater than 5 years old.  Current published research may not make its way into an educational programs curriculum due to time constraints.  In this fashion, the students may be ignorant to current research or niche research.

“Ineptitude: meaning that knowledge exists, but an individual or group fails to apply that knowledge correctly in a particular circumstance. “

This is common.  We know that therapists are not staying current with published research.  Time and access are two barriers to staying up to date on the research.  Just a quick example.  I dedicate 10 minutes per day to reading.  Even 10 minutes per day is hard to fit in with all the other hats that I must wear such as: business partner (http://www.goodliferehab.com/) , father, husband, running a separate Facebook page that interviews influencers and performing community lectures.  There is only so much time in the day and I can understand how some therapists will have a difficult time fitting learning into their day.  Barriers to obtaining current research can be the cost of a subscription to get the journal articles.  For instance, I pay over $1,000/year just to have access to research.  This is a big chunk of money when you consider all the other life activities that aren’t free.  Pair this with the fact that the “average” salary for PT is 80,000 ish and that students have well over $100,000 in debt.

, that $1,000/year over the lifetime of a career becomes expensive!

“For instance, through numerous scientific breakthroughs, there has been a repudiation of ‘folk’ treatments in our profession-such as hot packs or ultrasound for heat therapy-in favor of treatments based on scientific evidence.”

Going to PT should not resemble going to a spa! If you are going to PT and getting electrodes placed on you…getting hot packs placed on you…getting rubbed with gel while someone is moving a wand on your skin…or getting a rubdown…THAT IS NOT PHYSICAL THERAPY! On the flip side, PT should not resemble personal training! Going to your therapist and getting a list of exercises for you to perform independently while your therapist is chatting with others…IS NOT PHYSICAL THERAPY! The closes profession that I can equate therapy to is that of a teacher-student (and not always is the therapist the teacher!).  This healthcare relationship should be a personal relationship that takes place in a private setting allowing for open communication between the therapist and patient.  The patient should walk out of each session with more knowledge than they walked in with. The patient should understand why interventions are performed…or better yet why some aren’t performed.  We need to get away from the tradition of PT and move towards what the evidence tells us.

“However, despite the excellent EBP (current evidence) resources now available, ineptitude remains a major 21st century challenge in medical and rehabilitation care”

I have a dare for all of you reading this.  When you go see your next healthcare practitioner I want you to ask a simple question: “How much education do you get every 2 years?” In PT, we are required to get a minimal amount of continuing education to maintain our license.  DO YOU WANT TO BE TREATED BY SOMEONE THAT IS ONLY GETTING THE MINIMAL AMOUNT OF EDUCATION OR SOMEONE THAT IS DEVOTING TIME TO FURTHER THEIR KNOWLEDGE OUTSIDE OF THE MINIMAL STANDARDS FROM EACH STATE!

“…3 types of influence that have been shown to relate to the rate of spread of an innovation: (1) perceptions of the innovation, (2) characteristics of those who adopt the innovation or fail to do so, and (3) contextual factors”

The following will discuss how these all relate.

“First, the perceived benefit of the proposed innovation relative to its cost is the most powerful influence.”

For instance, a hot pack may not give much benefit, but it is cheap and relatively safe.  You will see this frequently in a PT clinic that sees a high volume of patients because of its relative ease of use and safety…assuming the therapist is asking you how you’re doing and checking a few things before, during and after.

Cold laser treatment is slower to take off in our profession because it is an out of pocket intervention…which means that your insurance company won’t pay for it regardless of whether it works.  This intervention is slower to be used in the clinic because it may be cost prohibitive for some patients.

“Second, rapidity of change is directly related to how compatible the innovation is to values, beliefs, and history.”

There are some “treatments” that become popular during years of summer Olympics.  In 2012, a specific brand of tape was seen on many of the “big name” volleyball players.  The thought was that it “kept things more supported”.  There is no research that conclusively states anything near this type of statement…but there is a lot of research that says the opposite.  We still see it used in clinics today…which is okay, if the rationale for using it is what is intended from our current knowledge base.  For instance, we know that it reduces pain and allows for increased ROM…sometimes.  If the patients are educated in this regard and not that it “keeps things in place” …go for it.  It seems like 2016 was the year of the octopus.  If you looked at one of the “world’s most famous swimmers”, it looked like he wrestled with an octopus underwater.  This technique has been around for centuries.  Some therapists are starting to do it because patients are asking for it.

“Third, the complexity of an innovation affects the rate of its adoption, and, as expected, simple innovations spread faster than complicated ones.”

Ultrasound, electrical stimulation, and traction are all very easy to perform…since the machine does most, if not all, of the work.  These were quickly adopted into our profession and are hard to convince some clinicians to stop using…regardless of what the evidence states.

More complicated interventions such as “critical thinking” are harder to adopt.  For instance, when assessing a patient with back pain or vestibular issues, there is a plethora of research showing that if we can classify it that we have a better outcome.  Classifying the problem requires (1) knowledge, (2) assessment, (3) application, which is a lot harder than just pushing a button on a machine.

Some of the personality types are as follows: 1. Innovators, 2. Early adopters, 3. Early majority 4. Late majority, 5. Laggards

A lot of these are self-explanatory, but it trends from those that jump onto something quickly to those that just hate change.

“Organizations that foster social exchange among its members are likely to see faster adoption of innovations as compared with institutions and organizations that foster habits of isolation and tradition.”

Essentially, workplaces that allow for communication will allow for change faster than workplaces that keep everyone separate.  This has to do with changing a culture.  A business that has a fluid culture (one that is easily adjusted), is more apt to change than one that has a strict culture.

“Publishing our work in journals is essential-but publication of research is not, by itself, sufficient if our goal is to change clinical practice. People follow the lead of other people they know and trust when they decide whether to take up an innovation and change the way they practice!”

This is huge! Any profession is a small world and PT is no different.  To push the profession forward, we must depend on more than just published research.  There are many influencers in our sphere such as Dr. Ben Fung, Dr. Jarod Hall, the team from PT on ICE, the team from Evidence in Motion, Dr. Richard Severin, and myself (I’m always trying to sneak my way into this group of titans).  By seeing others lead the way, it is much easier to follow.  Only the innovators and early adopters will feel comfortable at the front of the pack.

As a patient and therapist, you may want to assess your therapists/mentor and determine which of the 5 personality types he/she has.

 

Thanks for reading.  Please leave a comment on my FB page letting me know what you think.

EXCERPTS TAKEN FROM:

Jette AM. Editorial: Overcoming Ignorance and Ineptitude in 21st Century Rehabilitation. Phys Ther. 2017;97:497-498.

 

link to abstract

 

Did therapy help your knee pain? If no…continue to read. 

Did therapy help your knee pain? 

“Knee osteoarthritis (OA) is one of the leading causes of pain and disability worldwide”

This is an indication of how prevalent this condition is in the world. Arthritis is seen as a byproduct of aging, but this doesn’t mean that it directly causes pain.

“…exercise intervention has been shown to be efficacious and is recommended in multiple guidelines; however, its treatment effect has been reported to be modest.”

Everyone can benefit from exercise, but the extent of the benefit for patients with knee pain may not be that “miracle” that people expect.  

“Although the statistical effectiveness of exercise for knee OA has been clearly demonstrated and may be equivalent or better than commonly prescribed medications, the effect on pain reduction and function remains modest.”

Exercise is a powerful tool or at least among the most powerful that we have now. In saying this though, it is not a magic elixir.  

“The MDT approach has been extensively used to classify and treat patients with spinal pain. Studies have shown the MDT approach to be valid, reliable, able to successfully predict outcomes and associated with decreased lumbar surgery rates, pain, and disability.”

If this doesn’t sound great, then I don’t know what does! MDT (Mechanical Diagnosis and Therapy) is a specific assessment and treatment style that Is not taught in school. One must go through advanced courses and take a test to say that they are competent at using the method. Ask your therapist if they have taken any courses in the method and if they have achieved the certification through the Institute. This is the only way to determine if the therapist that you are seeing is competent to utilize the principles of the system.  

“The most prevalent and well-studies MDT subgroup is the ‘derangement’ classification. This classification has been described in all joints and has been associated with a rapid response to specific end-range exericses…”

Would you like your symptoms to rapidly improve? Who wouldn’t? Roughly 40% of patients with knee pain may have symptoms that respond rapidly to a single exercise. Turning off pain doesn’t have to be difficult. In many patients, it only takes a single exercise to reduce or turn off the pain. This has to be followed-up with a constant assessment in order to determine which exercises the joint will tolerate at a specific point in time in order to ensure that the symptoms do not return when not in the clinic. There has been a lot of research in the medical world regarding Low Back Pain, but this article is the first that I have seen using the same principles for osteoarthritic knees.  

“…significant treatment main effects were present for all primary outcomes. The MDT derangement subgroup had improved scores at 2 weeks and 3 months compared to the MDT nonresponder subgroup for all primary outcomes”

This is huge! This sentence essentially states that doing one exercise is more beneficial than doing many for a small subset of patients. Now for a little more information on a derangement. If there is one exercise that can greatly improve your pain, then there will be multiple exercises that either have no effect or make the pain worse. If your therapist is not at least looking for and ruling out this preferential exercise or direction of movement, you may be in therapy for a longer period with a longer list of home exercises. These exercises may or may not have a positive or negative effect on patient’s whose symptoms are rapidly reducible.  

“The physical therapists were credentialed in the McKenzie system, and results may not be applicable to non-McKenzie-trained therapists.”

This sentence stands on its own. Anyone claiming to use a method should at least be trained and credentialed in using the method. In the Joliet area, there are only two of us endorsed by the McKenzie Institute to utilize this method.  

 

In short, this study was performed on patients waiting to receive a total knee replacement, which means that they were shown to have severe arthritis on an X-ray. The patients receiving McKenzie-based treatment outperformed those receiving traditional evidence based guideline therapy and those that received no therapy. Seek out an MDT trained clinician if you are experiencing knee pain.  

 

I can be found at:

Functional Therapy and Rehabilitation

903 N. 129th Infantry Dr

Suite 500

Joliet, IL

815-483-2440

Get PT 2nd

“out of 137 patients, 100 had been recommended for spinal fusion. After evaluation, the group advised 58 of those patients to pursue a non operative plan of care”
There’s a slogan going around social media saying “GETPT1ST” I don’t know if I completely agree with the saying, but I can’t disagree with that either. The saying could just as well be get PT second. At some point a second opinion has to come in to play for a patient’s dysfunctions or pain. That second opinion, in my belief, has to come from someone without a financial stake in the surgery. This could be a physiatrist, PT, or a separate surgeon, which was done in the study cited. 
The take home point is that 58% of those recommended for spinal fusion were recommended to seek a separate form of care, thus advised to avoid the surgery initially. What this means for the patients is that a second opinion should always be sought out, because the person advising a plan of care is advising it from their perspective. I’d love to say that everyone has the patient’s best interest in mind, but I can’t. In that case, the patient must become more educated and advocate for him/herself. For instance, a surgeon does surgery, a physical therapist does physical therapy and a physiatrist does physiatry. We see problems from different lenses and therefore will advise different plans of care for varying presentations. Some patients need surgery and some don’t. Some patients need physical therapy and some don’t. We can’t say PT first because PT is not magic and can’t fix everyone’s issues. 
“As clinicians, we bring our own biases into the treatment plan for patients”
Want to decrease unnecessary surgeries? Have a multidisciplinary team do evaluations, researchers say. PT in Motion. April 2017:46. 

Revision ACL surgery

“anterior cruciate ligament… Sixth most common procedure performed by orthopedist, with more than 100,000 ACL reconstruction’s being performed annually in the United States”
In comparison to other types of surgeries, this is not a large prevalence. Anytime there is a surgery though, that injury is important to that one patient. This article cut my attention because of the author Dr. Bach. He practices fairly close to my region and I’ve seen previous patients from him. It’s always helpful to learn about the procedures that physicians perform in your area so that way you can be better prepared to treat the patients that these physicians operate on.
” The definition of ACL failure in simple terms includes symptomatic instability, pain, extensor dysfunction, and arthrofibrosis.”
  This essentially means that if there are continued symptoms after the surgery, that the surgery was a failure. I treated one patient previously, not from this doctor, in which the screw from the initial ACL reconstruction was never moved. The patient continues to have pain immediately upon starting therapy and I was beating my head against the wall trying to figure out why the patient continued to have pain. As a physical therapist we hate seeing patients experience symptoms that we can’t control. After sending the patient back to the doctor, it was found that the previous screw was in the joint space and causing the patient’s symptoms.
“Failures that occur within six months of reconstruction can be due to surgical technique, incomplete graft incorporation, and excessive rehabilitation or premature for trying to athletic competition.” 
The case described above, is an example of an error with surgical technique. I have also seen cases in which the patient was progressed through rehab to aggressively and the patient continued to worsen over the course of time. We have to honor the patient’s pain response when giving exercises and trying to make progressions.
“Revision ACL reconstruction’s are a “salvage” procedure to allow the patient to perform activities of daily living… Only 54% returned to their pre-injury level of activity”
To freeze this bluntly, let’s get it right the first time. As a physical therapist I will take part of the blame because sometimes our profession may progress patient a little to rapidly. We have to honor the patient’s pain and movement response.
There are a few parts of this article that I found very interesting. The doctors described patient positioning on the table and we are making conscious effort’s in order to reduce lumbar extension for prolonged periods of time in order to reduce strain on the lumbar spine. They went into great detail to describe how they remove the screw or insert the screw deeper from the initial ACL reconstruction surgery. I didn’t know that they could insert the screw deeper instead of just remove the screw all together.
“with the help of a physical therapist, and emphasis is placed on achieving full extension and equaling the opposite knee. Full flexion is usually achieved by 6 to 10 weeks.”
I fully appreciate the special mention a physical therapist in this article. The physicians did not have to describe this portion at the end of the article. PT’s are part of the medical team. If you or anyone you know is recovering from an ACL reconstruction, please seek out a physical therapist by word-of-mouth or through recommendations from friends and family. One could also look online to investigate the therapist that is treating you or your family member. The therapist that you were seeing should be educating you or your family member at each session and explaining the rationale behind each exercise, movement or hands on technique.
Excerpts taken from:
Creighton RA, Bach BR. Revision anterior cruciate ligament reconstruction with patellar tendon allograft: surgical technique. Sports med are thre revision anterior cruciate ligament reconstruction with patellar tendon allograft: surgical technique. Sports med arthrosc review. 2005;13(1):38-45.

Do your neighbors know what you do?

Do your neighbors know what you do?

 

“Many of our potential customers can’t tell the difference in therapists from one clinic to another”. This is an age old argument. Pepsi or Coke? Both colas and both had a strong following in the previous decades. I’d like to believe that the brands are losing strength in the days of paleo, crossfit and the resurgence of health and fitness. Not as much as I’d like to see, but it’s a start.

 

Let’s touch on this for a second. Why would Joe Shmoe believe that one therapist is any better than another? To start the argument, the APTA has stated that it would prefer that all PT’s place their licensed initials after the therapists name and then place all of the other qualifications after this. This means that my name is Vincent Gutierrez, PT, DPT, cert MDT, CFT. We get accused of alphabet soup, meaning that we have way too many letters after our names. We could easily cut that down by having the therapists establish themselves based on credentials and not on simply passing the licensure exam. For instance, if I wrote Vincent Gutierrez, DPT this would enable our customers to see that there must be a difference between BSPT, MPT and DPT. I’m not going into the turf war of whether or not one is better than the other, but we could allow clinicians to educate patients on why or why not the clinician chose to pursue one degree over the other. The public has a right to know what we do and how we are educated. This is a start. We make the assumption that a medical doctor went through 4 years of undergraduate schooling, 4 years of medical school and a few years to specialize prior to us going to the medical doctor. Us placing our initials after our names is the starting point to differentiation.

 

Past credentials, another way for Mr. Shmoe to understand the difference between therapists or companies is to soft market ourselves. When I say this, I don’t mean go for the sell, but instead educate the person in front of us while they are there so that the person that is in front of us can make a better choice of which provider to see for their problem when said problem arises. Otherwise, Dr. Superstar is no better than Dr. Squirrely in their eyes.   Every person that we encounter is a potential patient either for me or for one of my colleagues. I at least want to make sure that the potential patient has the information to arm themselves with confidence in making that decision.

 

Your “brand” is how people think of you or your company when the company’s name is mentioned.

 

Coke = Polar bears

Apple = easy enough for a toddler to use

Honda = 200K miles

Marianos = high end grocery shopping

TJ Max = bargain shopping

 

What words do you think of when I say your company’s name?

 

You can see that there are only two companies that my first though was positive for me. I want to exceed expectations for my patients so that when they think of my name they think of excellence and exceeding expectations.

 

Testimonials were previously against the law in our state. This changed recently and I recently learned of this. Testimonials seem to be the most powerful use of marketing for a service based profession. We are behind the times in healthcare. Let’s look at one brand and how testimonials are used. Crossfit has made significant gains in terms of business growth. How’d they do this? A simple Google search for “Crossfit testimonials” has yielded over 28,000 hits. This is how you brand a business. The same type of search for “physical therapy testimonials” yields about 4X that amount. Wow! That’s a lot of testimonials. What’s the problem with these numbers? PT has been around for almost 100 years and crossfit has been around for about 10. There are over 200,000 PT’s and only about 7,000 crossfit gyms. We need to do a better job of educating the public about the importance of PT using real people. Those that have experienced the joy of becoming pain-free, living life with improved function or simply receiving a consultation that assisted in a life-saving diagnosis. This is what we do! We need to make sure that our neighbors and their neighbors understand our value.

 

Theme from:

Barron B. Is Your Brand an Experience? The Importance of the “HOW” in branding for physical therapy private practice. IMPACT. January 2017:56-70.

Results based care

Results based care

 

I’m going to get away from typing out all of the quotes, which is what I have been doing for the previous year, for the sake of time. I have opinions that can be expressed without the need for the direct quotes. I’ll still link to the article so one can go back to read it if interested.

 

Health care is changing. We are moving from a fee-for-service type of setting to pay-for-performance setting. Some of us are thinking “about damn time!”

 

Fee for service indicates that a person gets paid for doing things to do. For instance, if I keep you for 90 minutes and do a bunch of stuff with you, then I would get paid much more than if I only spent 45 minutes with you. Now, if I see you for 90 minutes and see you 3 times per week for 4 weeks, then I would make a lot more money from the patient than if I saw for 45 minutes 1-2x per week. There is absolutely no incentive to get a patient better quickly. Do the patient’s realize this? I hope that this article goes viral so that the patient’s have a better opportunity to read this information. Some health care providers would hate for this to happen and other are thinking “HELL YEAH!”

 

Pay for performance: Some of the ways that this is being done is that a certain dollar amount is allocated for a specific diagnosis and this amount is paid regardless of how often or how many times I see the patient. I now have a huge incentive to get you better fast and to make you as independent as possible so that you no longer need to seek treatment for the same issue. If the patient can get better faster, then there is more money to be made in healthcare because we are not treating out of fear, but instead out of ambition. Some companies are afraid to discharge a patient because there may not be another patient taking that spot anytime soon. I’ve worked in these situations multiple times before, so I am not talking out of my A$$. Treating out of ambition allows the therapist to apply the evidence as best fits for the patient in front of us in order to get that patient better faster. No offense, but I want my patients to get better and leave. Hopefully, to never come back for the same thing again. I was listening to an episode of Mechanical Care Forum in which the therapist (Mark Miller) was describing an embarrassing moment in which Mark had a patient returning to therapy for the same complaint that the patient was there previously. He was proud because he thought the patient was coming back because he did such a good job the first time and the patient was satisfied with the treatment, but Robin Mckenzie, one of the most influential PT’s of the last century, noted that if the patient was actually better and if Mark did his job then the patient would know how to address the situation without seeking help again. I want to treat with the hope that the patient will only come back because they have a separate issue that needs a consultation for treatment. This is the ambition that I am talking about.

 

The article speaks of staying up to date on the literature, regularly attending continuing education classes, learning new approaches, tracking outcomes and adjusting treatment according to the patient. I would love to say that 100% of PT’s are performing all of the above in the list, but I can’t. There are countless articles speaking to the reasons that PT’s give for not staying up to date with the research, which indicates that there are some aren’t doing their professional or social duty. I take this stuff seriously. It’s Easter and I am typing about the stuff I just read. It sucks to take time away from work in order to find the articles, read them and then try to put the information out on the World Wide Web for patients and other therapists to read and criticize. I’d love to relax with my beverage of choice and just not think about it, but my patients and society, as a whole deserves better from my profession and me.

 

Anyway, Medicare is moving more towards a pay for performance method of healthcare and their goals are pretty aggressive. Medicare will have up to 50% of patients on this type of fee schedule by 2018 and for those that are still fee-for service, medicate will tie the payment to outcome measures in 90% of the cases by 2018.

 

I’m doing my part to educate, educate and overeducate the patient in order to get the patient on board with treatment. If I can get the patient to play an active role in the treatment, then I know that I have a better chance of getting that patient better.

Themes taken from:

Jannenga H. Tracking for success: Why outcome measures are essential to your practice. IMPACT. Jan 2017:53.