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Ultrasound use among OCS holders
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Ultrasound use among OCS holders - October 10, 2007 8:46:05 AM
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ysumpt2006
Posts: 116
Joined: March 31, 2005
From: Youngstown, Ohio
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Just read a quick abstract that suggested that despite the many reviews disputing the effectiveness of therapeutic ultrasound for the majority of msk diagneses, many holders of the OCS are still using it?
Why? Is this correct?
Do you use it?
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RE: Ultrasound use among OCS holders - October 10, 2007 10:06:57 AM
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SJBird55
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From: Michigan
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It's really sad, but I do believe that ultrasound is used by those with specialty certification as that literature indicates. I would tend to believe that it is a combination of things - potentially habit and management/referral expectations. We all have management stressing productivity and how better of a way to capture the required level of productivity in a day than to use ultrasound. Our referral sources don't keep up with our professional field and often times we don't take the time to educate them.
I know without a doubt that from claims that were analyzed and processed to Landmark (data provided by Ingenix) that nationally my peers (those in independent physical therapist category) are billing about 3.5 units per visit. Rounding things (during the visit on average) there are almost 2 units of exercise, almost 1 unit of some modality and less than 1 unit of manual therapy being billed out for services. I can't tell the actual averages from the bar graph provided to me.
The independent data from Landmark on mean service units per visit for physical therapists that are considered independent physical therapists does coincide with that abstract. The independent data from Landmark does not differentiate qualifications of providers.
It takes a lot of courage to buck a system and break away from "tradition." To not use ultrasound would basically be a choice that would rock the boat. Not many therapists choose to rock the boat. Maybe therapists like that 5-8 minutes of sitting and moving the wand around on the patient for that one-on-one down time? Maybe therapists believe that in every situation the short term "feel good" thing is what patients need and want? I don't know, but it is sad that something that has such little value is still a mainstream intervention.
And, no, I do not use ultrasound. I haven't touched an ultrasound machine in 7 years. I don't miss it. I also own my own clinic and I don't have one of them things in it. Patients come in with an expectation and I eduate and they generally get better. Every patient likes ultrasound... but ask them the next question - so did the part you liked about it last very long? They always chuckle and say no, but it felt good at the moment. I tell them that I go for something that lasts and not a short term feel good for the moment because I don't believe they should be wasting their time or money on something that isn't going to get them to the goals they just told me they wanted to achieve. Have I lost business by taking a stance and not offering it? Nope.
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RE: Ultrasound use among OCS holders - October 10, 2007 10:45:39 AM
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ysumpt2006
Posts: 116
Joined: March 31, 2005
From: Youngstown, Ohio
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As a "young" therapist, I have taken the stance against just throwing modalities at patients. I have been in the field as a licensed PT for about 14 months and I haven't used an ultrasound machine in at least a year. I do see it being used by everyone else though for shoulder, back, knee, and other "problems".
I'm trying to take the stand against things, but then I get the "why is your productivity down" when my patients are in and out with 2-3 units. Even if I go longer, there are many many times when modalities are not even used in my treatment plans unless there is an acute pain component to the diagnosis.
Hard to be the "rogue" therapist in a setting where the management is used to seeing other things being used by "seasoned pros".
I'm going to keep on keeping on, though. I just thought OCS holders were the gold standard for the ouptatient community.
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RE: Ultrasound use among OCS holders - October 10, 2007 11:14:17 AM
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orthotherapist
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I too have been the "rogue" therapist in the past - not as it relates to US but to other aspects of treatment. The best you can do is show that your outcomes are as good as the "seasoned pros", and your patient satisfaction is high. If you can show those two things they have nothing that they can say with regards to your care. If you show this and they still come back to "productivity" then I would question the position you are in.
What are they using to measure productivity/what is their "standard"
You may want to look for a position that lets you practice as you feel you should be allowed to.
With regards to OCS being the gold standard that may be a little bit of a stretch. They have proven that they have the knowledge to pass a test. There are many great therapists that have the knowledge but have not taken the exam. There are OCS therapists that i would not recommend. The iniitials do not make the therapist.
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RE: Ultrasound use among OCS holders - October 10, 2007 12:06:48 PM
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ysumpt2006
Posts: 116
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From: Youngstown, Ohio
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Our productivity is measured by units billed vs hours worked. Our standard is 90% and higher. Anything below and we get hit a little, bit. We do have an incentive to get higher than 95%, though--money (bonus).
I don't like the idea because it "can" breed overutilization.
Well, I know for a fact that my people are getting better without ultrasound, phonophoresis, etc. I also don't double up modalities (e-stim and game ready concurrently, for example) to gain productivity. Others do.
I guess I am just a little persnickety when it comes to some things. WOrst part is, these seasoned vets are taking on students and teaching them archaic practices. When I bring up anything contrary to "popular belief" either one-on-one or in a group, everyone argues their position to the death.
Of course, my director is not a PT so he doesn't understand what's going on, either. SUcks that the person who is preaching productivity isn't even aware of the ins and outs of the treatments.
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RE: Ultrasound use among OCS holders - October 10, 2007 12:49:08 PM
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orthotherapist
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SOunds a lot like my first job - Director without clinical knowledge with staff that is stuck in their ways.
Either exit stage right so they do not kill your enthusiam of being a therapist or continue to question things (with evidence to back it up). Be respectful in your presentation and some therapists may "come around". Those that don't are likely set in their ways/closeminded and work just to earn a paycheck. If that's the case you need to look elsewhere pronto.
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RE: Ultrasound use among OCS holders - October 10, 2007 1:39:47 PM
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ysumpt2006
Posts: 116
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From: Youngstown, Ohio
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quote:
ORIGINAL: orthotherapist
SOunds a lot like my first job - Director without clinical knowledge with staff that is stuck in their ways.
Either exit stage right so they do not kill your enthusiam of being a therapist or continue to question things (with evidence to back it up). Be respectful in your presentation and some therapists may "come around". Those that don't are likely set in their ways/closeminded and work just to earn a paycheck. If that's the case you need to look elsewhere pronto.
Already ahead of ya on that one. I'm gonna do what I do. Every time I question the enthusiasm, I get a note/letter/etc from a patient reminding me how much better he/she feels/moves/performs thanks to the help I gave him (I still find it hard to take credit for the recovery--I guess it's good I'm still humble).
Other opportunities are always there, just have to make sure the grass IS actually greener on the other side of that fence. I've had too many experiences with "less than ethical" places of employment.
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RE: Ultrasound use among OCS holders - October 10, 2007 2:15:44 PM
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orthotherapist
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To finish the story I ended up bing appointed Director (age 24) when hospital administration realized that things were the way they were. They made the non-clincial director the scapegoat (I still feel sorry for that poor chap as he was in a no win situation since he did not know what was going on as he just listened to the "seasoned professionals"). Then things got interesting but in the end the department was better off with good clinicians, happy patients, happy referral sources, and happy administration. I was forced to grow up quickly
Good luck
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RE: Ultrasound use among OCS holders - October 13, 2007 10:27:54 AM
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KAK
Posts: 200
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I am an OCS and will occasionally use US in select cases. Why? I have found it helpful in some cases- especially bursitis at the subscapularis insertion. I’ll also occasionally use it at the C-spine. It is certainly not my first option and never with out manual/exercise.
I have a great “case study” on its effectiveness. Several months ago, on a student’s first day, I did an eval with the student present. The patient was elderly, had a fused spine (old) and severe pain. She had been in a wheel chair for 7 months due to pain. She came with the dx of hip bursitis. You know the type, as you try to differentiate –everything hurts severely and you have no way to do an effective eval. I remember being a bit embarrassed as I was thinking I'm clueless as to where to begin with this patient- what a great first impression on this student.
Then, the patient, as if reading my mind, said the magic words, “I read on line that the only thing that helps this is US”. I had my treatment plan! US is what we did- to the bilateral SI joints and one of her greater trochanters. This, along with heat and about three gentle exercises, and in 3 weeks she went from WC to walking with a walker to no device. I still have the towel she made me as a thank you gift hanging in my kitchen- you know the kind that has a button crocheted on.
I realize it worked because she knew it would. My point is that occasionally, it does help with my outcomes; therefore I don’t throw it out completely.
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RE: Ultrasound use among OCS holders - October 13, 2007 7:08:15 PM
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SJBird55
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From: Michigan
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Could have been placebo too.
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RE: Ultrasound use among OCS holders - October 13, 2007 8:00:14 PM
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KAK
Posts: 200
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SJ-
That was my point in saying it worked because she knew it would. I wasn’t serious about it being a case study in US effectiveness. The student and I privately (with tongue-in-cheek) referred to the US machine as the “miracle machine.” However, I do think it may have its place in the clinic (though limited).
The point I made with the student was that not only will patients tell you what is wrong with them (if you listen well enough), but sometimes they might even tell you what they need to get better… I’m pretty sure if had I gone a different route with this lady we might not have done as well…Who knows?
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RE: Ultrasound use among OCS holders - November 11, 2007 9:42:30 PM
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Robert Capri, PT, MPT, OCS,STC
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sounds like this question has been up for a while. I have never really been a US user. Unless all else has failed or referral source strongle wants it . Recently I have been using this modality more. I think primarily because I am seeing patient's more acutely and often times I feel that, at least anecdotely it is helpful. Please watch closely UPITT they are really spending a lot of time and effort to re- validate or " study" the time-honored modality usage. Philadelphia panel 2001 killed this modality.
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RE: Ultrasound use among OCS holders - November 12, 2007 5:22:38 PM
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Chocco
Posts: 58
Joined: September 5, 2006
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Not a big uS fan, but i did use US in water on my finger After I jammed it pretty bad playing b-ball an injury that lingered on for weeks. It deffinately seemed to help. I am also troubled by studying whether us is effective or not. It seems that it could damage some of the credibility of our profession If something we stood by for years ( as a profession in general) is deemed to be not effective. A better alternative would be to compare alternate treatment like TFM for example and compare that to US. It would increase research in other areas and not solely draw attention to what may or may not be an effective modality.
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RE: Ultrasound use among OCS holders - November 14, 2007 11:55:02 PM
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jwb
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I still think US has its place in physical therapy, but its use has to be very selective. I don't typically use it. I believe more in manual therapy and exercise. And I educate my patients on the fact that modalities may give them some relief of their symptoms temporarily, but it won't fix the problem. This is a very broad subject. It depends on the condition and the outcome you want to achieve.
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RE: Ultrasound use among OCS holders - November 17, 2007 10:29:11 PM
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jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
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Crevidence,
Mostly agree. If I need deep heat (eg help to stretch a muscle or capsule) I'll consider it. And I'm learning to get off my high horse when it comes to pt's and MD's requesting it :P
What do you hope for with use on lat. epicondylagia? I've truthfully never considered it, but always looking to do better with this Dx. Thanks.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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