Saturday, November 1, 2014

What is wrong wrong with healthcare???

How far can health care dollars get divided?
So I'm still working this blog thing into my schedule. (Kids and life, huh?)

From my previous topic, it looks as if our of town patient is coming along. I'll see if I can get a better update.

Today's topic is about healthcare in general. Medicine (PT included) is about people, but it's also a business.

I received an email this morning that was just so disturbing that I feel like sharing. It's from a company that offers to create a "unique collaboration" between physicians and physical therapists. Essentially, the physicians invest in the company. My practice would get referrals from those physicians and the company would pay me for my work. (Standard Reimbusement - Whatever they take for their "management") The profit they render is divided with some going back to the Physician Investors.

Physicians would get paid for referring patients to PT.

It is definitely something that could make my business busier. So I emailed them back:


I'm not sure how you identified me as someone to contact using my email at SUNY Buffalo where I teach in the PT program there.

How do you rationalize or justify getting paid for NOT providing care? How exactly does this benefit patients in any way?

It is this constant cash grabbing mentality from outside interests that is ruining healthcare. I know you're rationalizing by thinking your are "connecting" people in some sort of way. Some way that couldn't be done in the absence of your group; but how exactly do you place a value on that? And how do you think you could keep it from being disproportionate?

It is this constant commercialization of healthcare that is ruining it! Physicians open their own PT practices under the guise of "controlling care". Controlling care to help provide better care. That is not even close to the truth. The truth is: the only thing they wanted to control was the potential revenue from the care they prescribed. There are business articles written in their professional trade magazines about it! Those articles had titles like, "You are letting $$$ leave your clinic with every PT script you write!"

The resulting model isn't one of caring, it is a model based on dollars. It results in massive volume clinics with a focus on the bottom line and NOT on patients. Physical Therapists graduate and take jobs at big practices while seeing 6 patients an hour. They just think it's the way it is. Patients just think that it's the way it is!

I had to open my own practice so I would NOT have to treat my patients like mere numbers. I actually had no other option to treat patients in a responsible manner. If I could, I would surely NOT go through all the pain and stress of being a small business owner. It's horrible! I busted my ass in PT school to help people, not to spend hours strapped to a desk! Hours spent, attempting to keep my small business alive.

But I am at my desk. I do the extra work that is required, because if I don't, the only options people will have are the big box, corporate like clinics, who just care about how many patients they can run through their clinic. I do this work, because I believe in a model that requires way more patient attention. I do this work, because I haven't given up yet. I somehow believe that if I can make it work, that others will follow; and gradually, over time, the level of care will improve and so will outcomes that are tied to that higher level of care.

The obstacles to this model really start with outside interests like your group who want to pull more out of an already miniscule revenue stream. You see an opportunity for enterprise. You see your own revenue stream for doing what? Soft tissue manipulation? Skilled therapeutic exercise intervention? A keen analytical eye focused on finding a patient's key movement dysfunction? Expert level joint manipulation delivered with hands that practiced this skill over countless hours to become effective?

I'm sorry Doug, but if you believe that what you're doing is going to make the world a better place... I just don't see how.

If you're in this to make some money... Hey man, it's America and America is a business. Go get yours bud!

I'm in this to help as many people as I can. Your offer does not fit into that goal at all.

Please, do NOT send me any more offers to join your group. I am clearly not interested in the BLANKETY-BLANK (replaced so I don't get sued!) group.



It's just something to think about. Many family insurance plans cost close to $20K annually. Those costs go up every year and reimbursement to the actual providers might go up every 5 to 15 years. Where does all the money go?

I'll have some ideas on where it goes in the coming weeks. Next week though we will post on some simple strategies to help reduce even chronic knee pain.

Please provide as much feedback as possible. And if the above topic doesn't sit well with you... Feel free to share this post with others. It's not opinion. It's truth!

Saturday, September 27, 2014

Going to PT or going it alone with your rehab?

The Thinking Face

So... I recently received a message from a friend about a friend of his. His request was rather simple: His friend suffered a horrific injury and after surgical repair, she needed to start PT. Unfortunately for her, she doesn't have insurance that would cover her physical therapy.

Hmmm... Well a very nice discussion for another time, about why someone would not be covered for PT, but for right now the dilemma is what to do. What to do indeed?

Well she doesn't live here in Buffalo, so I can't take her on as a charity case. I don't know anyone in her town that I could ask to do that either. The absence of care, or no advice at all and her function could be compromised for a lifetime. Clearly, the request cannot be ignored.

Some of my options would include creating a written home exercise program. I could try to create video direction for some therapeutic exercises and try weekly communication on her condition. It would be far from perfect, but better than nothing, correct?

One thing that is for certain: Going your rehab alone comes with some pretty severe risks, unless you just don't care about how you function in the future. A few than come to mind rather easily:

  1. Unrelenting, chronic pain: This is the type of pain that can bother a person even at rest. The sort of pain that can alter mood and judgement. Many times this can manifest itself into psycho-social problems like anxiety and depression. This not only can affect the patient, but also people who interact with them like, family friends and co-workers.
  2. Habitual drug usage: This often goes along with point number one. Often times, the pain can be too much for a person to bear, so they are aided by medications to reduce or relieve their pain. Unfortunately, these medications do nothing about the actual problem causing the pain. Many times they allow for movement that creates further injury and even more pain. Many of these medications are addictive and can lead to even bigger drug problems. There are plenty of stories for people with ruined lives that started with this sort of scenario.
  3. Dramatic (and unnecessary) Loss of Function: Most injuries when treated effectively will resolve with a return to your previous level of function. Many people even return to a higher level of function, since their rehab fixed other problems they were not aware of. Frequently we have patients who returned to a much higher level of performance after even a severe injury. However, the opposite can happen, (even with a minor injury) when proper rehabilitation is absent. This results in only having memories of function: "I used to be able to..."
  4. Spiraling decrease in overall health: We all know that proper movement goes along with a healthy lifestyle. Proper diet and exercise have been proven to offer us bother longer and more useful lives. When you cannot move well, or have pain with movement, it can be hard to stay healthy. Think about all the awesome things you want to do with your life. Every one of those things starts with having your health and being lively.
That was just a quick 4 reasons off the top of my head. There are plenty more reasons to treat your rehabilitation from an injury VERY seriously.

Now back to our young lady with the very serious problem and clearly a very serious need...

Clearly, I will NOT be able provide the care she needs, but I can also provide more help than NOTHING.

In my next few posts we'll see what we can provided and see how this whole thing turns out.

Hopefully, you're all having healthy days;