en-us https://www.intensedebate.com/users/333994 Comments by SelenaHorner http://twittertoolsbook.com/10-awesome-twitter-analytics-visualization-tools/#IDComment566573387 Thank you so much for taking the time to share ALL that information! Although my passion is being a physical therapist, I do "play" in the online world. LOVED, LOVED Twitonomy! I was looking for something that could capture what my followers liked - retweets in particular. Now I know and I can tweet better! Thanks! Fri, 8 Feb 2013 21:21:43 +0000 http://twittertoolsbook.com/10-awesome-twitter-analytics-visualization-tools/#IDComment566573387 http://physicaltherapydiagnosis.blogspot.com/2012/12/patients-win-maintenance-therapy.html#IDComment515343293 Once the cap is met, the patient pays out of pocket for services. Once the cap is met, services are no longer a "benefit" and Medicare beneficiaries can choose to see whoever they want - par, non-par, opted out and even anyone who is cash based only (physical therapists do not have the opt out option). When the service is no longer a covered benefit, because of the therapy cap, the providers don't even have to follow Medicare rules and regulations because the relationship is now between the provider and the patient. The provider would follow state practice act. Mon, 10 Dec 2012 15:44:12 +0000 http://physicaltherapydiagnosis.blogspot.com/2012/12/patients-win-maintenance-therapy.html#IDComment515343293 http://physicaltherapydiagnosis.blogspot.com/2012/12/patients-win-maintenance-therapy.html#IDComment515195451 The cap is in place for 2013... there isn't a Merry Christmas in this ruling. The "data" being collected starting in 2013 on function and "complexity/severity" won't be helpful at all. It isn't standardized, deemed valid or reliable, nor is it acceptable to analyze it as group data. CMS also hasn't figured out that value isn't necessarily limited to episodic care. I am happy to see the feds lost in the case, yes, but it's too late or it was planned to be this way so beneficiaries couldn't take advantage of the ruling due to the cap. Mon, 10 Dec 2012 11:47:33 +0000 http://physicaltherapydiagnosis.blogspot.com/2012/12/patients-win-maintenance-therapy.html#IDComment515195451 http://blog.myphysicaltherapyspace.com/2012/10/selling-physical-therapy.html#IDComment466022987 That idea evolved after Simon Sinek's publication of "Start with Why." Wed, 17 Oct 2012 14:51:25 +0000 http://blog.myphysicaltherapyspace.com/2012/10/selling-physical-therapy.html#IDComment466022987 http://blog.myphysicaltherapyspace.com/2012/10/selling-physical-therapy.html#IDComment466022089 Yes, Sinek does a great job helping us to see the difference between the lack of passion in how and what and the power of passion in why. You do have to remember, some of these ideas are new. The idea of a habit and how some decisions are made was new to me. I never thought about it that way. Why do you do what you do, Jerry? Wed, 17 Oct 2012 14:49:41 +0000 http://blog.myphysicaltherapyspace.com/2012/10/selling-physical-therapy.html#IDComment466022089 http://blog.myphysicaltherapyspace.com/2012/10/selling-physical-therapy.html#IDComment466020996 We do sell, every single day. The most sell happens during the initial physical therapy visit. I will admit, I do have a difficult time selling myself in general outside of the 4 walls of the clinic. I think that is because via our local Chamber of Commerce, my skin crawls whenever I run into certain members: they are always, always focused on selling. We can't have that either. I mean, at the Christmas parade, I'll walk on the other side of the street to avoid the sales pitches. I think my style would be more of enlightenment and education... how to know when a physical therapist is needed. Excited to know you are delivering a message during PPS annual and helping others to learn the value of selling... Wed, 17 Oct 2012 14:47:45 +0000 http://blog.myphysicaltherapyspace.com/2012/10/selling-physical-therapy.html#IDComment466020996 http://blog.myphysicaltherapyspace.com/2012/10/medpacs-view-of-physicaltherapy-time-to-set-the-record-straight-ptstat.html#IDComment460148613 Jason, an email was sent to me that mentioned a new generic outcome tool called "CARE" being rollled out. I interpreted the email to indicate "CARE" would be used for outpatient B. (What I could find on CARE did not indicate CARE would be the outpatient tool.) CMS is again going down an erroneous path. The current CARE takes 30-60 minutes to complete! That is SO not practical. medpac does need to think a bit about the regional variation statement. I believe CMS DOES have the data to analyze to truly determine the level of regional variation. CMS pays all claims. I'm of the belief beneficiaries could easily be categorized based on their level of medical spending (prescriptions included). I'd be willing to bet high spenders = those with greater frailty or severity. medpac isn't even trying to analyze what is available to them to actually look at regional variation. Categorize patients based on their overall spending high, average and low and THEN look at physical therapy costs. Who am I though? medpac needs to be brought up to speed on procedural codes and ICD-0. I believe they would have a very difficult time defending their position of who physical therapists treat AND what physical therapists do. There is an old report that indicates the top 10 ICD-9 codes and also the top procedural codes utilized by physical therapists. That old report full of data definitely describes who physical therapists treat and how much more reliably. They could take the data available to them and analyze the potential impact physical therapists do have with regard to downstream cost savings. Categorize patients as I mentioned earlier... then yank patients into 2 categories, physical therapy services utilized or not utilized... compare the costs. I also agree with Jason... there are already quick and dirty Quality of Life tools that could be used with every Medicare beneficiary by every type of provider to assist with learning cost-effectiveness. Wed, 10 Oct 2012 20:41:24 +0000 http://blog.myphysicaltherapyspace.com/2012/10/medpacs-view-of-physicaltherapy-time-to-set-the-record-straight-ptstat.html#IDComment460148613 http://blog.myphysicaltherapyspace.com/2012/10/infographic-pts-the-new-primary-care-providers-for-lbp.html#IDComment458360591 Very nice, David! I can definitely appreciate it (infographics take time)!Our society can't afford the train wreck any longer... Mon, 8 Oct 2012 16:49:11 +0000 http://blog.myphysicaltherapyspace.com/2012/10/infographic-pts-the-new-primary-care-providers-for-lbp.html#IDComment458360591 http://blog.myphysicaltherapyspace.com/2012/09/does-the-way-evidence-is-shared-matter.html#IDComment448579935 I'll hang in there an be an optimist. I don't think the right people or companies actually have this information in their hot little hands. I don't believe we've shared the story with the right individuals. Leaving change up to legislators and lobbyists is completely crazy because they can be bought. But... implementing a different strategy, sharing a targeted story and information that connects with the right individuals could lead to change - the momentum of these companies and individuals wanting a non-gatekeeper marketplace will drive change. Tue, 25 Sep 2012 20:23:49 +0000 http://blog.myphysicaltherapyspace.com/2012/09/does-the-way-evidence-is-shared-matter.html#IDComment448579935 http://blog.myphysicaltherapyspace.com/2012/06/physical-therapy-business-aliance-ptba-position-on-alternative-payment-system-aps.html#IDComment382365158 So, what we need is data on various diagnoses. Those with physical therapy intervention (actually provided by or supervised by a physical therapist, which will be a huge obstacle because of claims not clearly indicating a physical therapist was involved in the care) and those without physical therapy intervention. We need to figure out our "projected" value. Meaning... for some Medicare beneficiaries, they may not achieve traditional "outcomes," BUT may have significantly less utilization of more costly services in the future. In other words, a model also has to address a bigger picture than the "episode of care" and consider the downstream results... That's a good point, Tim - a perspective that really drives home the value of a physical therapist. It'll be quite difficult to factor that component into a model. Sat, 16 Jun 2012 13:13:19 +0000 http://blog.myphysicaltherapyspace.com/2012/06/physical-therapy-business-aliance-ptba-position-on-alternative-payment-system-aps.html#IDComment382365158 http://blog.myphysicaltherapyspace.com/2012/06/destination-autonomy.html#IDComment382361690 I've never heard Simon Sinek speak. Thanks for sharing that! (Link didn't work, but I googled it - he did a TED talk, wow!) I've read his book, "Start with Why." His video highlights points in his book. Our profession DOES need some positive inspiration! Sadly, it doesn't seem we have many in our profession who are dreamers. Sadly, it seems the majority in our profession like boundaries. Sure, feeling safe and secure is a good thing, but to dream and take a risk changes the world. The reason the RC on physical therapist accountability and responsibility had so much discussion was because the majority were focusing on the current traditional model and fear... fear that the traditional model will water down our profession and our care. The shackles are removed and we can dream... we can innovate... we do do what we inspire to do in whatever way we would like (within standards of practice and ethics). We have the skill and knowledge to turn the musculoskeletal world upside down! Why do we do what we do? Our profession is very, very good at sharing facts and figures. Fact and figures don't emotionally connect with others. Sinek does point the way to a great idea... the early adopters... if our profession can take just a moment and change it's strategy and focus on a very, very small group - the 18% who are early adopters - those companies and those people who aren't afraid of risks. Those companies and those groups would partner up, want, need, desire our services. When that happens, the other 60%, in time, will fall right into desiring our services also. The health care world, as we know it now, will be radically changed. Sat, 16 Jun 2012 13:05:55 +0000 http://blog.myphysicaltherapyspace.com/2012/06/destination-autonomy.html#IDComment382361690 http://blog.myphysicaltherapyspace.com/2012/06/destination-autonomy.html#IDComment379357094 I know which category you're in, Will. ;) Wait and see what the other 20% who are desiring full autonomy dream up! "Tradition" is fine for some, but so awesome to for our profession to create new models too! Tue, 12 Jun 2012 18:56:08 +0000 http://blog.myphysicaltherapyspace.com/2012/06/destination-autonomy.html#IDComment379357094 http://blog.myphysicaltherapyspace.com/2012/05/tyranny-of-the-or-why-rc3-should-be-implemented.html#IDComment374412019 What is there to "explore?" Worse case scenario is what? Sounds like the argument is 1) PTA relationship becomes worse or 2) quality of care decreases right? Maybe it's just time to trust that a licensed physical therapist is going to do his or her best in whatever situation with whatever staffing arrangement and delegate appropriately. Logically, the physical therapist would be responsible for training the "unidentified care extenders." AND there is this thing called communication - don't you think a physical therapist would be communicating with the "unidentified care extender?" If the issue isn't fear, then the issue is lack of trust. Apparently we all don't trust our colleagues to handle being fully responsible and accountable for ALL aspects of care, including delegation of care. Allowing RC 3-11 also requires an amount of humbleness because in reality it also means that previous leaders within the association errored in their leadership by allowing policies to define physical therapy that suggest services can only be provided by a PT or PTA. Tue, 5 Jun 2012 10:28:22 +0000 http://blog.myphysicaltherapyspace.com/2012/05/tyranny-of-the-or-why-rc3-should-be-implemented.html#IDComment374412019 http://blog.myphysicaltherapyspace.com/2012/05/tyranny-of-the-or-why-rc3-should-be-implemented.html#IDComment374064952 RC3-11 opens doors of various possibilities. Will it improve patient care? Sure... our profession hasn't even tapped into opportunities that exist for improving patient care. Could our physical therapists be within a manufacturing facility providing services to injured workers - delegating tasks to engineers, medical assistants or techs? Sure... Would that improve the current model of seeing a worker comp physician, being prescribed drugs and having diagnostic tests ordered? Probably. Could physical therapists work in a collaborative setting comprised of a MA, nurse practitioner and physician assistant? Definitely - as the physician shortage hits, patients with musculoskeletal problems will not be adequately managed because we are the experts in this area and we aren't even included in these types of scenarios to assist with the upcoming shortage. RC3-11 has the potential to create more positions and different practice settings for the physical therapist. It creates opportunities to be a solution for the upcoming train wreck. Physical therapy is only physical therapy if provided or supervised by a physical therapist. The PTA isn't in a leading role... and the PTA isn't really a solution for the upcoming problems in health care. In some of the new opportunities that I can think of a PTA might not even be needed. RC3-11 could create fewer positions for the PTA, sure... but what will come of that is how well care is delivered. If care can't be delivered in a way that is expected or satisfactory to patients or outside stakeholders, those providing that care will slowly become extinct. Mon, 4 Jun 2012 22:11:44 +0000 http://blog.myphysicaltherapyspace.com/2012/05/tyranny-of-the-or-why-rc3-should-be-implemented.html#IDComment374064952 http://blog.myphysicaltherapyspace.com/2012/06/ptba-position-on-responsibility-and-accountability-for-the-delivery-of-care.html#IDComment374055470 What if? What if the opportunity arose for a physical therapist to practice within an ER department with ER docs, nurses, MAs? If a medical assistant did part of the exam... and then passed the patient to a nurse who did part of the exam.. and then decided a physical therapist needs to be involved. Would it be wrong to have the physical therapist use the information from the MA and the nurse to make clinical decisions? What if the physical therapist was the first provider the patient saw due to a musculoskeletal complaint. What if the physical therapist wanted crutch training to be provided? What if ortho techs were trained in gait training with crutches? Would it be wrong for the PT to delegate that responsibility? What if as health care reform occurs, it becomes necessary for physical therapists to be included within primary care offices because musculoskeletal conditions will be triaged to the physical therapist? Wouldn't it seem reasonable that a physical therapist could delegate aspects of patient care to a MA or nurse or even a PA (depending on what the patient needed)? As physical therapists begin to have more of a consulting/managing role, the opportunities to work with a wide range of medical and other professionals exists. Should we pigeon hole ourselves into just have a PTA at our side? What if... what if we became the primary musculoskeletal expert for large companies shuffling injured employees for consultation? Is it unreasonable for a physical therapist to even delegate aspects of the care to say an engineer - an engineer who's responsibility is employee safety & equipment design? We really don't need any more thinking or planning or debating or stalling... As Seth Godin would say, it's time to ship. Mon, 4 Jun 2012 21:52:08 +0000 http://blog.myphysicaltherapyspace.com/2012/06/ptba-position-on-responsibility-and-accountability-for-the-delivery-of-care.html#IDComment374055470 http://blog.myphysicaltherapyspace.com/2012/06/ptba-position-on-responsibility-and-accountability-for-the-delivery-of-care.html#IDComment372586319 The whole lack of moving forward has to do with fear... delegates need to remember the 80/20 rule. Full physical therapist autonomy to determine how care is provided was to be implemented July 2012. We haven't even implemented full autonomy yet to know a mistake was made! If RC 1-12 passes, we have no strategy to adapt to future changes. Our profession loses longevity if we do not evolve in our ability to delegate & manage patients. If RC 2-12 passes, is just a stall strategy. The issue is stalled until July 2014. What is there to explore when physical therapists have had their hands completely tied and are not able to implement innovative strategies? Why pass this?? If RC 3-12 is passed, an indefinite stall strategy is in place, can't have that. Scratching the effective date and adding the amendments is wrong. The RC needs to pass but the July 1, 2012 date needs to remain. Sat, 2 Jun 2012 15:12:20 +0000 http://blog.myphysicaltherapyspace.com/2012/06/ptba-position-on-responsibility-and-accountability-for-the-delivery-of-care.html#IDComment372586319 http://blog.myphysicaltherapyspace.com/2012/05/body-wash-shampoos-conditioners-and-bars.html#IDComment362938264 Thanks for your thought, Joe. We have plenty of standardized outcome measures that work perfectly fine for individual patients and yes, PSFS is definitely one of them. The issue... it is highly likely that if outcome data is to be included on claim forms, the payers will data mine. When data mining begins to happen, they will notice that for the exact same ICD-9 code that some patients make huge gains in a short amount of time and others take way longer to make less gains in a longer amount of time. Potentially the payers will then want to regulate the amount of change required to occur in a defined amount of time. We can't stand back and allow a trainwreck like this to happen. There are quite a few variables that impact the outcomes and if those variables are not taken into consideration apples and oranges are being compared. I honestly don't believe we even have a reasonable system currently existing for the 65+ age group because the current systems I have seen do not merge performance data with self-report measures. For example... a community dwelling 70 year old female with low back pain who is able to ambulate faster than 1 m/sec would probably have better outcomes than a similar female who ambulates slower than 1 m/sec. There may be differences in individuals who do or don't have dementia. Certain medications may affect outcomes. All of these little nuances aren't taken into consideration when reporting an outcome measure. Sat, 19 May 2012 01:01:38 +0000 http://blog.myphysicaltherapyspace.com/2012/05/body-wash-shampoos-conditioners-and-bars.html#IDComment362938264 http://blog.myphysicaltherapyspace.com/2012/05/body-wash-shampoos-conditioners-and-bars.html#IDComment362933753 A standardized measuring system for all patients will be a fail... RTI and their DOTPA project will be a fail. Sat, 19 May 2012 00:50:41 +0000 http://blog.myphysicaltherapyspace.com/2012/05/body-wash-shampoos-conditioners-and-bars.html#IDComment362933753 http://blog.myphysicaltherapyspace.com/2012/05/direct-access-you-are-ready.html#IDComment360720782 Hi Erson, Ross & Boissonnault had a 25% self-referral rate also. Another paper I read at the end of last year with a small sampling of clinics in the US also had a small self-referral rate. I wasn't completely you out with regard to why there is less self-referral rates. Our profession isn't taking one bit advantage of a situation that is beneficial for consumers. With self-referral the number that matters is new self-referral patients. The higher the percentage would mean consumers choosing physical therapists. Excellent on getting out in the community, building awareness, educating and letting consumers know they have another choice! Actually, they have an excellent choice when they are injured - physical therapists. Athletes are loyal and once you get a couple of them and do what only you know how to do best... word will spread among them! Your self-referral rates will definitely increase! Tue, 15 May 2012 10:27:15 +0000 http://blog.myphysicaltherapyspace.com/2012/05/direct-access-you-are-ready.html#IDComment360720782 http://blog.myphysicaltherapyspace.com/2012/04/what-does-direct-access-mean.html#IDComment351971125 I'm going to be completely blunt. Physical therapists do NOT have direct access in Medicare. There has been a Medicare Patient Access to Physical Therapists Act since 2005 (from what I can find). I don't believe there is currently an active bill introduced on this particular issue. I believe anyone hanging their hats on a signature on certifications and recertifications is potentially running a risk. If I were an auditor, I would not interpret a signature on a cert or recert as proof that a patient was under the care of a physician or nonphysician. Some states are WAY less restrictive than Medicare. Some states have direct access meaning a patient can walk through the doors and a physical therapist can do what a physical therapist does without any extra hoops or requirements to meet. Tue, 1 May 2012 13:20:20 +0000 http://blog.myphysicaltherapyspace.com/2012/04/what-does-direct-access-mean.html#IDComment351971125