Pulmonary Rehabilitation (Full Version)

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scollins -> Pulmonary Rehabilitation (July 30, 2001 2:59:00 PM)

There have been hundreds of studies demonstrating the efficacy of pulmonary rehabilitation. However, this practice area is still underfunded by insurance carriers. And often, patients with pulmonary conditions are not even referred to PR.
My question is therefore, how do we know aspects of patient care that are expected to improve, will improve with more evidence. I agree that clinically it is very helpful for determining what treatments will be useful, and determining prognosis this information is very important. However, I do not feel this information will solve all the problems. What do you all think?

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Sean Collins
Assistant Professor
University of Massachusetts Lowell
3 Solomont Way, Suite 5
Lowell, MA. 01854-5124
978-934-4375




mcap -> Re: Pulmonary Rehabilitation (July 30, 2001 6:49:00 PM)

Sean:

We have had many good threads on this one. I have always championed evidence based practice. We need it for so many reasons, ethics among them. And while you may not be able to improve reimbursement with evidence, you may prevent future cutbacks and you may at least have something to fight with. Without evidence, there is very little to stand on.

That having been said.....very few of us are so naive as to think that evidence will solve all problems. You are correct in your assertion that evidence does not necessarily lead to payment. Reimbursement is driven by many other factors including politics, power, money, influence, tradition, public perception, etc. In fact, if you look at medicine in general, there is a lack of evidence for MOST things. Scary but true.

A recent article in the New York Times highlighted a report commisioned for the NIH. The purpose of the report was to examine the major problems facing the healthcare system.

The article summarized the report as follows....."The scandalous fact about American health care, he and other experts have noticed, is how little of what physicians do is backed by careful scientific evidence. A committee of the Institute of Medicine concluded this year that the nation's health-care system is a "tangled, highly-fragmented web that often wastes resources by providing unecessary servies and duplicating efforts, leaving unaccountable gaps in care and failing to build on the strengths of all health professionals."

Other health care practicioners have had no shortage of criticism about physical therapy. I think it is time for them to look at their own practices!!!!

So, since so little is actually evidenced based......remibursement decisions must be driven by some of those other little things [IMG]http://www.rehabedge.com/forums/frown.gif[/IMG]

Just some thoughts......

mcap




Andrew M. Ball, MS, PT -> Re: Pulmonary Rehabilitation (August 3, 2001 4:38:00 AM)

Mcap,

Very well stated. I would add however, as I always do, that the problem with our profession is that most within it have an inablity to conceptualize physical therapy without insurance. Most of us lament the impact that third party payers have upon our practice, but fail to admit to ourselves that if left to a direct free market (like dentistry or optometry - where most pay out of pocket for these services, or at the very least pay up front and then expect subeqent reimbursement), physical therapy would fall flat on it's face.

Our profession has a problem with demonstration of outcomes, that's true. Many of us don't even read peer-reviewed literature on a daily basis in an effort to enhance both professionalism and outcomes in physical therapy practice . . . but we have a bigger problem.

Marketing.

Several years ago, I wrote the first of a long string of controvercial articles in which I said plainly that PTA's have long been the marketing experts in our profession. I know of no other profession that allows its assistants to dictate the boundries of its practice to its supervising profession to the degree that physical therapy does. Try to find parallels in legal assistants, medical assistants, physician assistant, dental hygenists, chiropractic assistants - and you'll find very different intradisciplinary dynamics.

Some people read this as a dig on PTA's. IT IS NOT. I'm simply saying that we should recognize the strengths of our profession and encourage the APTA to organize PT's section on Admin, with PTA leaders, and develop a strategic plan for the marketing of physical therapy services. There is a nod given to this, but the DPT concept has intead taken center stage . . . instead of the other way around.

This would be at the root of my eariler discussions with Jan Richardson way back in the day. I belived, and still believe, that outcomes and marketing of the profession should be the primary goals of the profession, and the DPT a vehicle toward that. I thought that I represented the majority in that view, but I got the distinct impression that as soon as I implied that the DPT shouldn't take the spotlight in the vision statement (though I belive it should be there), Dr. Richardson simply but me (in her mind) in the same class as other PT's who were trying to tell her that DPT is the Devil incarnate - which was never my position - and stopped listening.

I like Dr. Richardson personally, and respect her professionally, but I think that putting DPT primary, with outcomes and marketing as the vehicles for establishing the value of the DPT, was the wrong thing to do. Politically, it turned out to be a bad move for her and I suspect that this issue played a major role in her presidential defeat to Ben Masey, Jr.

Personally, I'm more comfortable with Ben's approach to this issue. The language of the vision statement hasen't changed much, but the tone of it has . . . and it's much closer to using the DPT and evidence-based practice as a vechile rather than as the cure for all that ails us.

Drew




scollins -> Re: Pulmonary Rehabilitation (August 3, 2001 5:33:00 AM)

mcap and Drew,
Thank you for taking the time to post your insightful replies. I agree with you on all of your points. This venue is a great step toward attempting to bring the profession together, and the topics posted seem to be a good compass for guiding therapists. As I often mention when presenting my research to groups of therapist that have taken the time to attend the conference/seminar/course, one of the problems is that despite the existence of clinical practice based on solid concepts and theory (perhaps even with some research evidence) the therapists that are participating in these discussions, and attending the conferences are not the therapists that need to be taught. I should say, we all can learn from continued participation, but it is the therapists that are NOT participating, but are practicing that most likely epitomize the qualities we refer to as "the problem with the profession." Does this make sense to you both? or are my thoughts not making it clearly to the page?
Have a great day!

------------------
Sean Collins
Assistant Professor
University of Massachusetts Lowell
3 Solomont Way, Suite 5
Lowell, MA. 01854-5124
978-934-4375




mcap -> Re: Pulmonary Rehabilitation (August 5, 2001 8:07:00 PM)

Sean:

I (and probably Drew) couldn't agree more. We have a real problem here. You can even see it in this board. There are hundreds of registered users but only a few of us ever debate here.
Rehabedge aside......it is an important issue. The average therapist demonstrates very little interest in research. They don't care to read articles, involve themselves in studies, or even question the very techniques that they are charging money for. It is discouraging.

I can't tell you why. It is probably a combination of their own personalities, their situations and their educations. I think that PT programs do a good job of calling for evidence based practice. But not many faculty members regularly reference studies during their lectures. Perhaps there is just no time to go into it. Futhermore there is often a gap between the clinical and academic teachers. The clinical faculty members that are brought in, in some cases, may have less of a research focus. However, students rely on the clinical faculty more and more as their education progresses because they are teaching them what to do with patients.

A complex issue to be sure.....

mcap




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