Power of Change
Monday January 18, 2010
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Where Are They Now?
Treatment setting: Percentage
Private outpatient office or group practice: 32.4%
Health-system or hospital-based outpatient facility or clinic: 21.6%
Acute care hospital: 11.6%
Academic institution (post-secondary): 8.7%
Patient’s home/home care: 6.5%
SNF/ECF/ICF: 5.1%
School system (preschool/primary/secondary): 4.5%
Subacute rehab hospital (inpatient): 2.7%
Health and wellness facility: 0.5%
Industry: 0.5%
Research Center: 0.3%
Other: 5.5%
Source: APTA
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“I think [in the midst of] healthcare reform is an excellent time to be a PT — if you are willing to learn new ways of working and new ways of serving communities or your population,” says Roger Herr, PT, MPA, COS-C, a physical therapist in Seattle and a member of the American Physical Therapy Association government affairs committee and the health information technology task force. “What I mean by that is that people will still have needs [for PT]. People are aware that they need to function and they have goals with that. The baby boomer population wants to age well. So there’s such a great opportunity there. I have recruiters constantly looking for more therapists and the main reason is that there is an aging boomer population, and people see the need for providing physical therapy across multiple settings.”
Trepidation about the future is reminiscent of the crisis of confidence the profession weathered in the past with the advent of managed care and then again with the Balanced Budget Act of 1997, notes Stephen M. Levine, PT, DPT, MSHA, a partner in the Fort Lauderdale, Fla., office of Fearon & Levine, a national consulting firm focusing on payment policy, payment strategies, and practice management in outpatient rehabilitation settings.
“We thought, ‘The end of physical therapy is coming,’” he recalls of those bygone eras. But “we adjusted and we recognized that the times were changing. That wasn’t the end.”
Dealing with the inevitable changes of healthcare reform will be a similar challenge — formidable but not impossible, he says.
“If we can demonstrate that we are better than any other healthcare provider at maximizing a patient’s or client’s movement-related abilities, then the issues of whether or not our services are valuable — and the dollar amount associated with that — I think in many ways will work itself out,” Levine says. The responsibility for documenting that evidence rests with all therapists — not just PT faculty, Levine and others note.
“The truth of the matter is that every physical therapist, regardless of the setting they work in, has the opportunity to participate in the development and review of that evidence,” Levine says.
“Evidence is not just randomized clinical trials. Evidence is case studies. Evidence is the data that reflects that you can tie a particular outcome to a particular intervention,” he says. “Every time you submit a claim to an insurance company, whether it’s Medicare or some private insurance company, you are submitting pieces of data — data that reflects a diagnosis, data that reflects the procedures that you were providing, data that reflects how long the patient is in your clinic.” That data can be mined for evidence of the efficacy of treatment, he says.
Changes in reimbursement policies could lead to changes in treatment venues as well.“We’ve become much more creative and much more innovative in terms of non-traditional means by which to bring in revenue,” says Patti Naylor, PT, MS, assistant professor of physical therapy at Maryville University of St. Louis. Health and wellness programs are on the upswing, she says. Many PT gyms allow former patients to use equipment for a nominal fee, a welcome alternative for the geriatric sector to a full-scale commercial gym.
PTs also can be innovative within their current practice venues, says Herr. For example, he’s seen telephone support in conjunction with hands-on care work as a care model in home health for some patients. New technology and online tools also could play a larger role in the future, he says. “I definitely think there are new ways of working. I don’t know what they will all be at this point.”
PTAs are not immune to the call for action. “I think the physical therapist assistant is an ideal, established, credentialed person to do that role,” Herr says. But he adds that “we need to demonstrate that to payers and other groups.”
Healthcare reform, as Naylor says, is a double-edged sword. “You can use it to your advantage and make the most of it, or if you sit back and do nothing, you can suffer the consequences,” she warns. “Let people know what we’re capable of doing. Tell people how we can fit into the system. We can’t wait for it [the future] to be created and let other people tell us how they expect us to be a part of it.”
Anne Federwisch is a contributing writer for Today in PT.
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