Wednesday, June 24, 2009

AB 1152 And Physician-Owned PT Services

We interrupt our regularly scheduled programming at this time for a special announcement of the Elite Sports Physical Therapy Broadcasting System............

Assembly Bill 1152 (AB 1152) is scheduled to be heard in the Senate Committee on Business, Professions, and Economic Development on Monday, July 6th in CA. This bill would make it clear in the law that physicians and podiatrists may employ physical therapists in their professional corporations. Though many of these clinicians argue that by providing in-house rehabilitation services they are better able to oversee the physical therapy their patients receive, there are a few facts they are leaving out.

Referral For Profit Is About The $$$$
These physicians are billing for the physical therapy services provided; and therefore, they are profiting from them. Studies have shown that this poses an inherent conflict of interest for the patient, as the physician may be more likely to refer them for in-house physical therapy versus an independent physical therapist practitioner who may be better qualified.

In a June 16, 2009 Wall Street Journal article, the independent commission that advises Congress in Medicare payments said that "when physicians have a financial interest in imaging equipment, they are more likely to order imaging tests and incur higher overall spending in their patients' care." So could that also apply to physicians who own physical therapy practices? Could they continue to refer patients to their own in-house physical therapy even if it is unnecessary or outcomes are less than optimal?

In this article, in the Journal of the American Medical Association (JAMA), they found that utilization, charges per patient, and profits were higher when physical therapy and rehabilitation facilities are owned by referring physicians.

In one more article posted in Medical Care, they found that after a physician group took ownership of a specialty hospital, there was a 650% increase inn patients referred for "complex" spinal fusion surgery. 650% people!!! At the same time, they decreased their referrals for "simple" spinal fusion surgeries, compared to an increase in such referrals from non-owners.

Physician Owned Physical Therapy Is Not About The Care
The JAMA article also discovered some interesting service characteristics of the physician owned PT practices in their study. They found that the physician PT facilities employed fewer licensed physical therapists and licensed physical therapist assistants to perform physical therapy, so that those licensed professionals that were employed spent significantly less time per treating visit with the patient. So not only may you be getting a less qualified PT (remember a highly qualified PT will cost the doctor more $$ to employ them), but you are also probably going to spend less time with the PT you do get to see in these physician owned facilities.

This would be in stark contrast to a freestanding physical therapist owned clinic, that needs to earn the respect and trust of the medical practitioners and citizens of the community with their quality of care because referrals for them are not "automatic."

So What Does This Mean?
As consumers in the healthcare system, we need to be vigilant in preventing any inherent conflicts of interest that get in the way of quality of care. For AB 1152, you can do either or both of the following:

1. Please make a phone call and send a letter of opposition to your local state Senator. To find your state senator, click here and enter your zip code. Click on the state senator's name to access their contact information. Please make your phone calls of opposition to the senator's Sacramento/capitol office.

2. Fax a personalized letter of opposition to the fax number also found on the state senator's site through the above link. For a sample form letter or more details, you can go to the CPTA Legislative Action Center here.

REMEMBER, you need to be the person taking care of your own health. YOU are your best patient advocate. And that includes ensuring that those delivering your care, are doing it for no other reason than to see you get better.

Once again, we apologize for this interruption. We will return you to your regularly scheduled broadcasting shortly.........

Tuesday, June 23, 2009

The Back Pain Epidemic

Did you know hat Americans spend at least $50 billion each year on low back pain? Did you know low back pain is the most common cause of job-related disability and a leading contributor to missed work? And the only neurological ailment more common in the United States than low back pain is headache.

Most incidences of low back pain are temporary and the result of trauma to the low back from sports, overuse with housework/yard work, or a motor vehicle accident. This usually results in inflammation and muscle spasm in the low back, creating a problem that is mechanical in nature. There are situations, however, where the source of pain is a damaged structure like a protruding disk, a fractured vertebrae, or a pinched nerve. In these cases, it's very important that you seek the advice of a physical medicine and rehab physician or a spine specialist for the next step in caring for your back.
Finding The Right Balance
In treating many patients with mechanical low back pain (and even some of those with structural issues), I have found that there is usually an imbalance in hip flexibility, thoracic mobility, and core strength. In other words, most of my patients have tight hip/leg muscles, they are very stiff in the thoracic spine (usually from poor sitting posture), and have weak abdominal and back muscles due to deconditioning. Most of the time, correcting these imbalances will provide a significant reduction in pain and improvement in function.

For example, I had the opportunity to treat a crew athlete that had been diagnosed with several disc protrusions in his low back. One physician told him that he would never be able to row again. Another doctor said, "Who knows how many of these crew athletes have protrusions. They sit in that prolonged position in the boat for practice and competition. If we did an MRI on all the crew athletes, we might find some with the same thing. But how many of them are actually in pain? Go ahead and treat the imbalances first and see what happens."

Well, that's what we did. This crew athlete had very poor hamstring flexibility and core strength. We worked very hard on this for 8 weeks and he started to see improvements in both of these areas. Soon after, guess what: His Back Pain Decreased!!! And before he knew it, he was back in the boat with the crew team rowing!!

Treat The Cause, Not The Symptoms
Fortunately for the crew athlete, his second doctor was able to think outside the box, or should I say the back. (A very good doctor might I add. If you would like more information about him, email me at jchun@espt-ca.com). This is something that we are seeing more and more as medicine (and physical therapy) is evolving. Just because someone has back pain, you don't just keep treating the back. This can provide relief, but without addressing some of the other issues mentioned above, the back pain will likely return.

Most physical therapists use modalities like ultrasound, electrical stimulation, cold lasers, and traction to address low back pain. But that should not be the only thing they do. If it is, you need to find yourself another therapist. Those things will only address your pain. A physical therapist that looks at the whole person and not just the diagnosis, will help patients find the root cause of their back issues. They will help patients find balance in their bodies. Balance between flexibility, mobility, and strength, so that the low back pain is relief is for longer periods and the occurrences are fewer and farther between.
For more information about how physical therapy can help decrease low back pain or for a comprehensive evaluation, contact us at Elite Sports Physical Therapy at (510) 656-3777.

Next blog post........Simple Stretches and Exercises for Low Back Pain.

Thursday, June 4, 2009

Barefoot Running- Au Naturel or Unnatural?

Sorry I haven't posted in a while. By request, I will post an article shortly on low back pain with a few exercises you can try if you have problems with your own back.

But today I ran into this article which has an interesting take on running barefoot and the new "minimalist" campaign taken by Nike and some other footwear makers: Should-you-toss-your-running- shoes-and-just-go-barefoot?

Nike has their Nike Free shoes which are supposed to mimic the bare feet and allow the foot to adapt and strengthen as you run. The result is supposedly better biomechanics because one does not need to "rely" on footwear for support. The article even cites some runners that have noticed increased foot/leg pain with their new shoes.

Please check out my two part blog here and here, before jumping to conclusions. There is such a thing as too MUCH support when selecting a running shoe. And there is such a thing as too LITTLE support. Make sure you see a physical therapist or a podiatrist for proper footwear recommendations. I have seen many a running shoe store employee make the wrong recommendation. Only a proper biomechanical foot evaluation can give you a clear picture of the proper type of shoe for your foot.

Feel free to contact us at Elite Sports Physical Therapy at 510.656.3777 if you have any questions. Just ask to speak with a physical therapist and will guide you in the right direction!!!