“If you want to change the world, you have to enroll others in your plans and vision.”
About 2 years ago I started a blog. It was just for fun and the premise behind the blog is this “the only knowledge wasted is the knowledge not shared”. I saw this quote on a t-shirt; a blog was born.
My goal is to provide high quality content to readers through this blog in order to assist them with making decisions regarding choosing a health care practitioner. The secondary goal is to educate physical therapists at least up to the point of at patients. It sounds cynical that I believe that some patients have more knowledge than the PT, but I also believe that the patient has more to lose and more at stake than the PT.
The PT only has a paycheck at stake, maybe a reputation. The patient has life limitations and issues that may prevent them from truly experiencing life. That way more at stake than the PT has on the line. In this fashion, I have seen patients becoming smarter over the years through forums, FB groups, reading blogs and watching videos.
The reason why I say high quality content is because there are a lot of lies and misinformation on the World Wide Web (internet). Healthcare professionals prey on the weak and ignorant to take their money using scare tactics and unrealistic hype.
I ain’t got nothing to sell you other than making you a better human through work. Nothing ventured, nothing gained.
I have increasing demands on my time with a family, managing multiple clinics, treating patients and community involvement.
My posts will become fewer and fewer as I try to fit them into my life instead of fitting my life around my work.
Love your life or change it
Dr. Vince Gutierrez, PT
“If you must play, decide on three things at the start: the rules of the game, the stakes, and the quitting time.”
This is a lesson that learned later in life. I entered into an agreement under one pretense (set of rules) and after entering the agreement and quitting my job, the rules changed. At that point, I had to ride out the decision that I had made to quit and try to make the best of it.
I wasn’t fully aware of the rules; they changed during the game.
After making the decision to leave my current job, in order to open a clinic with a friend near where I created my following, it was decided that the clinic would be 35 miles away! This was a major blow because now I was starting completely fresh and had no following (although a few patients chose to make that drive). I was able to get in front of over 1,000 pairs of eyes in person and 160,000 pairs of eyes through social media and newspapers.
Unfortunately, I still didn’t know all of the rules until well into the game and at that point my wife and I realized that I couldn’t win the game and we started to discuss quitting time.
Luckily for me, I busted my ass to build my following in this new area. A local business wanted both my skills and my work ethic. The fact that I was able to bring new faces to the clinic was a bonus.
The clinic needed another PT within a few months and through hustle and blessings, I was also able to build a following among PTs, so finding another PT that wanted to work with me wasn’t difficult.
I am now making more money working fewer hours and learning more about the business of health care than I had during the previous 12 years of my career.
I had to learn the lesson the hard way.
Whenever you are entering into an agreement, both sides need to understand the rules of the game, the risks and rewards and when to call it quits.
“You got to know when hold em; know when to fold em; know when to walk away; know when to run.”
We’ve all been there! That place in which we are sinking instead of swimming. You ain’t alone.
Hear my story below.
Check out my episode “A penny saved is a penny earned” from Movementthinker: a physio’s perspective on Anchor: https://anchor.fm/vincent-gutierrez/episodes/A-penny-saved-is-a-penny-earned-e298p5
“Low back pain syndromes (LBPS) affect more than 65 million Americans…For approximately 16 million people (8%), back pain is persistent or chronic…”
If you have a little bit of free time, you can read about back pain here.
“…a quarter of all referrals for outpatient physical therapy and one-half of all outpatient physical therapy visits are related to patients with LBPS.”
Hey New Grad ✊ are you 👂?
If you want to get really good at something and ensure job stability, then you should learn as much as you can about back pain.
If one out of every two visits per day is related to back pain, we should all be very comfortable with this diagnosis.
In my first job, I’d say that I had 2,500 visits per year with about 95% of those pertaining to the spine.
“Resnik et al reported that patients who spent more than half of their treatment episode of care with a physical therapist assistant reported worse functional outcomes and utilized more visits compared with patients with less physical therapist assistant involvement.”
Again, this is the second post in the series on PTA’s usage in the outpatient setting. You can find the first post here.
“It is generally assumed that practitioners must possess many years of clinical experience to achieve the best results with patients and that years of experience are associated with better clinical outcomes.”
What?! I don’t agree with this.
Unfortunately, not all experience is good experience. I’ve read Tony Delitto state in an article that one year repeated twenty times is it ideal. I would much rather have a PT with two years of experience and two years worth of learning from mistakes.
“Almost half of the sample had chronic low back pain.”
This is in line with some of the statistics that I’ve heard stating that back pain makes up about 40% of all chronic pain.
“The top 3 diagnoses were pain (34.8%), sprain or strain (25.5%), and herniated disk (19.3).”
About 90-95% of all back pain is “non-specific”, meaning that we can’t attribute it to a specific tissue strain or sprain. Herniated did a are common in the population, but we can’t always attribute a herniated disc (HNP) as the cause of pain.
“On average, patients in the best clinic performance group improved 19.2 OHS points, while patients in the worst clinic performance group improved an average of 16.4 OHS points.”
This is great news!
This means that on average people get better. I used to work in a clinic in which the manager would try to schedule people with back pain as soon as possible. If we know that they will likely improve and they improve on our watch, then they are likely to use post hoc reasoning and attribute improvement to seeing the PT.
I used to joke with patients and say that they simply need to breathe the city air in the basement of the hospital in order to improve. Obviously, it’s a joke, but we have to tell patients that most injuries improve with time.
“Patients in the best clinic performance group utilized, on average, 7.7 (SD = 4.1) visits per treatment episode compared with 7.9 (SD = 4.1) in the middle clinic performance group and 9.3 (SD = 4.9) in the worst clinic performance group.”
This is where it gets interesting. There wasn’t a major difference in outcomes on the scoring improvement, but some clinics needed an extra 2 visits compared to other clinics, on average.
If an average PT sees 5 evaluations per week and it takes an extra 2 visits, then that ONE PT is averaging an extra 20 visits per month (assuming half of the evaluations are back pain). This means that the therapist keeping patients for more visits is making the clinic an extra $2,000 per month from taking longer to discharge patients.
“…clinics that were lower utilizers of physical therapist assistants were 6.6 times more likely to be classified into the high effectiveness group compared with the low effectiveness group, 6.7 times more likely to be classified into the low utilization group compared with the high utilized group, and 12.4 times more likely to be classified into the best performance group compared with the worst performance group.”
This is essentially stating that clinics that use PTAs with a lower frequency in outpatient tend to be better in terms of outcomes and faster to discharge. This mirrors the link to the study from above.
For me this is interesting because I would have never thought to ask the question in the first place. It’s good to see that someone is doing this research to help clinicians in their decisions to 1. Choose between PT and PTA school and 2. Utilize PTAs and how to best utilize PTAs in an outpatient setting.
“Our strongest finding was that clinics that had lower utilization of physical therapist assistants were much more likely to be in the “best” category of each type of group (i.e. highest effectiveness, lowest utilization, and overall performance).”
Link to article
“Proliferation of these staffing models (increasing the use of PTA’s and aides) has been driven by managed care organizations, the introduction of prospective payment systems, and low reimbursement rates, as well as workforce shortages in allied health.”
For those that are unfamiliar with physical therapy and what the titles mean lets do a quick refresher:
PTA = licensed physical therapist assistant (high school + 2 years)
PT = licensed physical therapist (Bachelor’s or Bachelor’s + years)
aide = no required degree with on the job training (no degree needed)
MPT = Master of physical therapy degree (Bachelor’s plus 27 months)
DPT = Doctor of physical therapy degree (Bachelor’s plus 33 months)
Based on the above, one can see that the aide would be paid less than the PTA. The PTA would get paid less than the PT based on education level alone and all other things are equal.
When insurance companies cut pay to professionals, companies have to decrease their costs in order to continue to make margin. One way to cut costs is to have fewer PT’s and more PTA’s or aides. The ethics/legalities of the decision are for a different day.
Some insurance companies are refusing to pay for services provided by PTA’s.
The reason that I bothered to look at this research was a large discussion that took place on a professional FB page in which PTA’s were arguing that the care shouldn’t change from PTA to PT, seeing as PTA’s can perform most treatments that a PT can perform.
I decided to look into this to see if there was a difference and I was shocked by what I found, based on my own experience working in a hospital system. On the same note, I wasn’t shocked based on some of the reports that I hear from patients and others in the profession.
“Use of support personnel in outpatient therapy settings can double the number of patient visits a therapist can manage per day, thus increasing clinical productivity.”
If I am a PT making $50/hour (using round numbers to keep it simple) and in a typical day I could treat 10 patients with an average reimbursement rate of $95 (please go watch all the videos from Dr. Ben Fung ), then I would cost the company $400 dollars, but make the company $950 dollars. A gross profit, with the removal of only the PT salary, of $550 dollars per day.
Now, if we have that same PT making $50/hour and a PTA making $30/hour (again round numbers to keep it simple), with each therapist seeing 10 patients per day, then the following numbers are the result. The salaries would cost $640, but the therapists would generate $1900/day. A gross profit, with salaries of the therapists removed, of $1260/day.
As you can see, the company would be able to generate more money by hiring PTA’s instead of a second PT. The question then becomes is it cost effective to have the PTA compared to the second PT. The answer at a glance is “of course”!, but looking a little deeper may force a company to weigh values (i.e. profit or outcomes) before making that second hire.
“While some advocate use of support personnel to increase productivity without loss of quality, others warn that an over reliance on support personnel can negatively affect outcomes and compromise quality.”
This is essentially the discussion that occurred on FB. Some people say that PTA’s provide the same quality of care as PT’s and others state that PTA’s offer less quality care than PT’s.
I’ve worked with rockstar PTA’s (plus my wife is a PTA so I am already a little biased) and I’ve worked with some PT’s that I would never refer a patient to (no offense if you think that this is you).
“Three dependent variables were analyzed: high PTA utilization, number of visits per treatment episode, and patients FHS (functional health status) at discharge…high PTA utilization, defined as a patient seen by a PTA 50 percent or more of the treatment time”
High PTA utilization, in this study, meant that the PTA was seen by the PTA for over 50% of the visits.
Again, I have worked in locations in which this was true and locations in which we had no PTA’s, so I have seen the results from both.
Looking at treatments per episode is a means of measuring efficiency of treatment. It may not be the best measurement, but is one way of looking at treatment efficiency.
Looking at outcomes is one way of looking at effectiveness of treatment. Again, it may not be the best way, but it is one way.
“…less than 2 percent of patients were treated by the PTA for more than 75% of the treatment time, and 8 percent were treated by the PTA 50% of the time or more.”
I’ve been in clinics without PTA’s and with PTA’s. This stat will be correlated with the amount of PT’s/PTA’s in the clinic.
In private practice, it was 0 PTA’s. In the hospital we had 1.5 PTA’s for 4 PT’s. Currently, in my practice there are 2 PTA’s for 1.5 PT’s.
“The second dependent variable, number of visits per treatment episode…We believed that fewer visits per treatment episode were a marker of greater efficiency of care”
This is debatable by people. I’ve actually been involved in these on-line debates. Some people will fight that more visits equals better, but more is not always better.
If we can get patients better in shorter visits, then this seems to be ideal to me. If additional visits would correlate with increased function, then I would be all for increased visits if the patient is willing and able to pay for increased visits (time and money).
“The majority of physical therapy care was delivered by PTs with no reported assistance from PTAs.”
Again, in a clinic without PTA’s, there will be no reported assistance from PTA’s. This study used data from FOTO, which included private practices and hospital based practices.
“PTAs were involved in the care of patients only 35% of the time. High PTA utilization was relatively uncommon, with only 7.7 percent of the patients seen by PTAs more than 50% of the time.”
This is interesting. It is becoming more and more common to find clinics advertising/marketing that the patient will only be seen by a PT, or even a step further a Doctor of Physical Therapy. I don’t know how well this marketing is going.
When seeing it, it subconsciously implies that a DPT is better than a PTA. I think that this is very individualized. For example, a PTA that has continued to improve over the years through independent study may be a better clinician than a PT that never sees patients (administration/teacher/manager).
“Medicare patients who were seen in private practice were 48 percent less likely to have had high PTA utilization.”
Some insurance companies require that a patient be seen by a PT and prohibit PTA’s from treating patients. This will skew numbers towards the PT in private practice.
“Treatment with a therapy aide for 1-25 percent time and greater than 25 percent compared with 0 percent, and high utilization of the PTA were associated with 1.8, 2.6 and 2.0 more visits, respectively.”
Lets break this down.
Being treated by a therapy aide for 1-25% of the time resulted in 1.8 more patient visits per episode.
Being treated by a therapy aide for > 25% of the time resulted in 2.6 more visits per episode.
Being treated by a PTA for greater than 50% of the time resulted in 2.0 more visits.
Remember, an aide is someone that may not have any college experience or degrees. The aide is not legally able to treat patients that are payed by the government.
Utilizing an aide only results in slightly more visits than using a PTA! Why is this?!
I see employers trying to cut costs by hiring more aides (not ethical to call it physical therapy if it is not provided by a licensed physical therapy professional IMO).
If it doesn’t change the outcomes though, who’s to argue against it?
I can see both sides of the coin. Margins (profits) in physical therapy is small, so cutting costs is a business decision.
Providing quality care is something that IMO we should all strive for.
“Greater than 50% time spent with the PTA was predictive of lower discharge scores as was time spent with a therapy aide.”
This part may be the most important statistic in the article. Seeing someone other than the PT led to worse outcomes.
This is the statistic that I was looking for because of the original question asked.
In other words, the PT will get a patient better than a non-PT and do it faster in an outpatient setting.
Strong words for businesses and people looking to go to PT school.
What is the future of PTA’s? I don’t know. Medicare just announced that they will be reducing reimbursement rates for PTA’s in an outpatient setting. Pair this with the small margins in physical therapy and the question becomes is it profitable to hire PTA’s in an outpatient setting, seeing patients according to Medicare rules?
“…our analysis shows that Medicare regulations for continuous in-room supervision of PTA’s in private practice are associated with a decreased likelihood of high PTA utilization.”
“High utilization of PTA’s, and use of therapy aides were each independently associated with more visits per treatment episode, and lower functional health. Thus our findings suggest that use of care extenders such as PTA’s and therapy aides in place of PT’s is associated with more costly and lower quality care delivery in outpatient rehabilitation.”
I advise all people to look to the source:
“Burnout…is a syndrome of depersonalization, emotional exhaustion, and a sense of low personal accomplishment leading to decreased effectiveness at work…primarily affected those in ‘helping’ professions”
Hey!… Hey!… You!… PT’s!…Are you listening?!….
Does this sound like someone you know?
“The high prevalence of burnout among physicians results in lowss of engagement and commitment…5 out of every 10 physicians affected by burnout”
Loss of engagement and commitment with patients. Hmmm? How many therapists do you know that are “punching the clock”?
I have a problem with a lack of engagement. It just isn’t something that I tend to do often and I have a short attention span. Maybe not as short as the new average of 9 seconds, but pretty darn short. I just shift the engagement to something different.
A therapist that isn’t engaged with the patient is problematic. Patients are coming to us for our professional opinion and placing trust in us to help them along their journey of pain or functional restoration. To have loss of engagement places that trust at risk.
Not only is trust lost between the patient and the physical therapist, but also between the patient and the profession of physical therapy.
Remember young Jedi, YOU REPRESENT THE FORCE (by force I mean the PT workforce). Your burnout makes me look bad. Not that it’s all about me, but really…it’s all about me.
50% of physicians are affected by burnout?!
I haven’t seen any studies on prevalence in our profession, but I hope it’s not that high.
“Many factors contribute to burnout, including high workloads; an inefficient environment; problems with work-life integration; lack of flexibility, autonomy, and control; and loss of meaning in work.”
I’ve seen research showing that treating 20 patients per day may lead to burnout. I don’t know if it’s the 20 patients or the notes that come along with the 20 patients, but….20 patients!!! REALLY?
At my busiest time, I was only seeing about 15 per day. This may be why I have yet to experience burnout from treating patients.
An inefficient environment. I have experienced this multiple times. Sometimes people and companies are just set in their ways and don’t see a good enough reason to change.
Problems with work-life integration: this is what I am struggling with right now. Is the juice worth the squeeze? This is a phrase that I am thinking of more and more currently. When I think of how many hours that I am away from my kids and wife, I have to think (or my wife makes me think) about where do I want to be in life 5 years from now. Managing a clinic takes a ton of time. If you have never tried to build a “brand”, it takes a lot of time and work in order to get a personal brand out to the community.
Autonomy and control: I haven’t personally experienced a loss of control in the clinic, but I hear from PT’s all over the country that their boos/manager/director almost dictates the care in order to create a “comprehensive care plan”. Now this sounds all good and nice and all, but in the end the question has to be asked…Why? Why does the boss want a comprehensive plan?
The reason is no different than any other business and it has to do with money. Clinics make more money by doing multiple different treatments than providing one treatment that may have the best outcomes. It’s sad…but I hear it frequently.
“Physicians who suffer from burnout are impaired and they and their organizations are at risk of having higher rates of medical errors, less professionalism, lower patient satisfaction, and lower productivity, as well as more turnover and suicidal ideation”
Does burnout sound good?
Not like the burnout that I would do on my BMX bike as a kid or in my F-150 as a teenager.
Burnout leads to major issues at a personal and corporate level. I wonder though if the companies care about burnout. Turnover happens in physical therapy. Although it costs money to train a new therapist, it may not matter since many companies see a PT as a widget instead of as an autonomous practitioner. If one therapist can easily be swapped out for another, is burnout an issue at the corporate level?
Rhetorical questions of course.
“Organizations that make investments in leadership development experience substantially higher returns than those that do not.”
This is a great quote. Invest in your people, more so than seeing your people as an investment.
For instance, when you put money into an IRA, it sits there and you hope it grows (at least matches the 10% historical APR). You are passive in this role. Hopefully money makes money. This is what typically happens in a company. The employee is expected to go out and grow individually, which benefits the company, although the company may not take part in that individual investment.
I would like to see it more as owning a home. This is an investment also. It averages about a 2% gain per year, but the individual living in the home has to actively care for the investment in order for it to keep growing. I would love for more businesses to see employees as an investment for which they should foster care. High tides raise all ships. When the employee is successful both on an individual and business sense, everyone wins.
“Clinician engagement is empirically linked to more effective organizations, with outcomes including lower turnover rates, superior clinical outcomes, better patient experience, and superior financial performance”
Does this sound like a positive experience for clinicians and patients alike?
If the clinician is engaged in not only treating patients but also regarding the health of the business everyone wins.
Some therapists don’t see themselves as business people, which is a shame because if we don’t get the patient in the door, then we can’t help that person. We have to feel confident in attracting our customer (someone with functional complaints that may or may not relate to pain), educating our customer, selling to our customer and then accepting their money. Sales doesn’t have to be a bad thing. I have been reading Rabbi Daniel Lapin and have learned that money is just as much a show of appreciation and gratitude as it is a financial transaction.
“Physicians experience highest levels of engagement when they have a degree of control over their work environment. Engage Physicians tend to receive higher patient satisfaction ratings.”
This is an indication of autonomous practice. When a clinician gets to dictate care, instead of having care dictated to the clinician, then everyone wins again.
“Combating physician burnout is a twofold process that involves 1. mitigating the structural and functional drivers of burnout and 2. bolstering individual resiliency.”
This is the Mayo Model to try to reduce burnout in physicians. This appears useful for many other health professionals also.
Quick Link to the article here
“During Fiscal Year (FY) 2017, the Federal Government won or negotiated over $2.4B in health care fraud judgments and settlements…$2.6B was returned to the Federal Government or paid to private persons.”
Put this into perspective. If you were born today and started counting one…two…three…four, you would get to 2B right around retirement age. This is of course assuming that you don’t sleep.
That’s a lot of money!
What’s important is to read that the money was returned to the government or paid to private persons. This means that the Government is at least paying this much out to health care providers in order to recover the money at a later date.
There is a saying in health care…”it’s not about how much you make, but how much you keep that matters”.
“In FY 2017, the Department of Justice (DOJ) opened 967 new criminal health care fraud investigations…filed criminal charges in 439 cases.”
Again, I’d love to say that health care is a field full of altruistic people, we we know that some people suck! They just suck. They take advantage of people. They may have been bullied as a child and feel the need to get payback. They may have been the bullies and just continue to try to take advantage of others. It doesn’t matter the why, but they can’t be trusted to do the right thing when placed in a situation in which personal gain is an option.
“HHS-OIG also excluded 3,244 individuals and entities from participation in Medicare, Medicaid, and other federal health care programs.”
When a health care provider attempts to defraud a federally funded program, the health care provider can be excluded from seeing any patients that participate in these programs. For instance, if I were to be a shady individual and overbill or bill for services that I didn’t actually provide, the government can then say that I am no longer allowed to see these patients. The government could also enter into a corporate integrity agreement with the person or company and allow them to see patients, but the company would have to prove that steps are being taken in order to minimize abusing the system.
“Under the joint direction of the Attorney General and the Secretary, the Program’s (Health Care Fraud and Abuse Control Program) goals are:
- To coordinate federal, state and local law enforcement efforts relating to health care fraud and abuse with respect to health plans;
- To conduct investigations, audits, inspections, and evaluations relating to the delivery of and payment for health care in the United States;
- To facilitate enforcement of all applicable remedies for such fraud; and
- To provide education and guidance regarding complying with current health care law. “
Imagine that you have the full force of the Federal Government tracking you as a health care professional. How confident are you that you are doing everything correctly? We are responsible for complying with health care laws and regulations.
It’s unfortunate, but there are many therapists that still struggle with how to bill appropriately and will just take the word of another health care provider instead of looking up the rules and regulations.
“Relators’ Payments: $262,095,000…are funds awarded to private persons who file suits on behalf of the Federal Government under the qui tam (whistleblower) provisions of the False Clams Act”
In my opinion, this is where it gets interesting. If anyone sees an injustice of abuse or fraud and reports it to the government, the government may pay that person(s) a percentage of what is recovered from the abusing person or company.
About 10% of what was recovered was paid out to individuals and groups that reported this fraud.
Someone is hitting the lottery by doing the right thing and reporting on those that are taking advantage of the system or are ignorant of the rules of the system.
“The return on investment (ROI) of the HCFAC program over the last three years is $4.20 returned for every $1.00 expended.”
If you are the federal government, “would you put more or less money into trying to recover more money from those committing fraud or abuse?”
I don’t see these recovery attempts to slow down over the years.
“Health Care Fraud Prevention and Enforcement Action Team (HEAT)…The Medicare Fraud Strike Force teams are a key component of Heat. The mission of Heat is:
- To marshal significant resources across government to prevent waste, fraud, and abuse in the Medicare and Medicaid programs and crack down on the fraud perpetrators who are abusing the system and costing us all billions of dollars.
- To reduce health care costs and improve the quality of care by riding the system of perpetrators who are preying on Medicare and Medicaid beneficiaries.
- To highlight best practices by providers and public sector employees who are dedicated to ending waste, fraud, and abuse in Medicare.
- To build upon existing partnerships between DOJ and HHS, such as our Medicare Fraud Strike force Teams, to reduce fraud and recover taxpayer dollars. “
If you are in healthcare…are you listening?!
Does this sound personal?
This is to crack down on perpetrators costing us billions of Dollars.
“DOJ and HHS have expanded data sharing and improved information sharing procedures in order to get critical data and information into the hands of law enforcement to track patterns of fraud an database and increase efficiency in investigating and prosecuting complex health care fraud cases…enables the DOJ and HHS to efficiently identify and target the worst actors in the system.”
As a therapist, you should be shaking in your boots…if you are breaking the rules. When the DOJ gets involved, it gets serious.
If you aren’t sure if you are one of the “worst actors in the system” you should check out the statistics.
“In January and February 2017, 4 defendants pled guilty…conspiracy to commit health care fraud and conspiracy to commit money laundering…submit false claims to Medicare and Medicaid for among other things, fraudulent physical and occupational therapy services…patients received medically unnecessary services that were later falsely billed to Medicare and Medicaid…totaling over $55 million were submitted to Medicare and Medicaid in connection with the scheme”
This may be more than most people can perceive regarding fraud, but it doesn’t always start this way. I’ve heard that it starts with overcharging by a couple of minutes and when a person doesn’t get caught, then the billing becomes more and more unethical. Before you know it, the person is billing for thousands of dollars of services that weren’t actually performed.
“In March 2017, an owner of several physical and occupational therapy clinics in the Central District of California was sentenced to 5 years and 3 months in prison after pleading guilty to health care fraud conspiracy…ordered to pay more than $2.4 million in restitution to Medicare…instructed therapists and others to bill Medicare for physical and occupational therapy services that were medically unnecessary and not provided”
This is unfortunately all to common. I received calls just in the past year from PT;s in Minneapolis, Houston, NYC, and San Diego describing similar situations. This is happening all across the country, but very few people are saying anything about it. It is much easier to ask opinions of others that have no vested interest in the topic than it is to actually call the compliance officer for the company or call the office of inspector general.
“In July 2017…a 2-count indictment against 5 high-billing medical professionals who worked at a network of Brooklyn-area clinics where patients were paid illegal kickbacks in return for subjecting themselves to purported physical and occupational therapy, diagnostic testing and other medical services.”
Kickbacks are illegal. Kickbacks come in many forms. Money is the easy one, but there are others. I’ve heard of free sports tickets, free trips to medical conferences, paying patients to show up for sessions, waiving co-pays for all patients in order to keep them in the clinic, etc. etc. etc.
If you are a patient, this is illegal and needs to be reported. If you are a therapist, this is illegal and needs to be reported.
“In October 2016, the owner and medical director of Christian Home Health Agency in New Orleans were sentenced to 8 years and 6 years in prison, respectively, after being convicted of health care fraud for billing Medicare for home health services that were not medically necessary or were not provided.”
People go to prison. Some worry about whether they will be shunned by their job, so they don’t report the wrongs noted in the clinic. Some people worry about whether they will lose their job, so they don’t report it. People are going to prison. Jobs come and go, but time served isn’t something that one can just walk away from. Walk away from a negative situation while you still have time…or you may find yourself doing time.
To see the report in whole click here
To learn more click here.
I came across this quote today in Black Belt Magazine. (Read topics from other fields because you will expand your knowledge and may find information that applies to your mastery).
This quote is perfect for the profession of physical therapy.
Are you in this profession for the long term?
If so, study every day. Learn a little bit every day. Master a topic every day. You have time to reach that mastery. You have you’re entire career to become a master at physical therapy.
If this is a stepping stone to something else (I ain’t gonna hate ya for it), then why bother to master anything at all?
If your goal is to go into the business of owning a clinic, teaching courses, becoming a professor, then it doesn’t matter if you “master the profession”. It only matters that you master that which is your goal.
Happy thought for the day.
I went months without setting a PR when I was powerlifting. It was horrible. When I first started, I made gains weekly just by walking into the gym and breathing the musky air from the dungeon. I could stand next to the strongest guys, and women, in the world and get stronger from their aura. It wore off over time and I had to come out with some tactics to get stronger. I’ve used chains, rubber bands, static holds and changed the tempo of the repetition. I did what I had to in order to make progress, albeit slow progress at times.
Now, I’m a Doctor of PT and I am managing a clinic. During the Fall, times were a boomin’, but the winter brings with it a season of decreased want to leave the house. People don’t want to come to therapy multiple times per week in order to alleviate pains that have been there for years. “It can wait another month”, they think. “It can wait until winter’s over”, they think. If they only knew that the solution could be easy!
Wait…that’s my job to educate them!
I was once told that if you build it, they would come. Well, that guy was wrong and I’m busting my behind in order to get them to come.
These times of scarcity allow for some time to create my brand, donate my time to the communities and allow me to learn more about the people that I will serve. It’s hard to watch the numbers go down in the gym, but it’s very frustrating to know that I am going through these patterns over again 10 years later.
There is a light at the end of the tunnel. Here’s the light from 10 years ago.
“Dealing with the temporary frustration of not making progress is an integral part of the path towards excellence.”
Christopher Sommer from the book Tools of Titans