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RE: One expert will lead to better care
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RE: One expert will lead to better care - June 25, 2008 7:39:06 PM
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proud
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quote:
In my opinion, it will be the consumers themselves that will weed out the practitioners that suck...
Not so much. I know people that have been going to the same chiropractor for years( sometimes 10+). Their neck pain is worse than it was 10 years ago, they have more impairments, they go more frequently....yet there they are....proclaiming how amazing the chiropractor is. No clue.
BTW....it does seem to apply to chiropractic more than PT simply becuase of manipulation( more chrio's manip than PT's for now) that seems to have a profound pain modulating effect which of course is potrayed as something much more important by the salseman.
People LOVE...LOVE elaborate explainations for their pain. People would rather be told what is wrong with them no matter how erroneous than have someone tell them the cold hard facts about persistent pain( ie: they own it and only they can overcome it).
Ask yoourself why cost is skyrocketing over NMSK issues including persistent pain? It's more choice that's what. More choice....confused public....always seeking the magician to cure what ails them. Of course it's never there...
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RE: One expert will lead to better care - June 25, 2008 8:17:45 PM
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SJBird55
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From: Michigan
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Hold on proud... you need to pay attention to the full sentence, not just the aspect you want to be attuned.
quote:
In my opinion, it will be the consumers themselves that will weed out the practitioners that suck... but that will only happen as consumers experience different companies or practioners and only then will they know the difference.
In your example of the same chiropractor for years... the person hasn't experienced anything different to make any type of comparison.
The reason that costs are skyrocketing has to do with lack of professionals educating on pain and understanding pain; it has to do with a lazy society that would rather pop a pill versus be accountable; and it sometimes has to do with a "wait and see" kind of attitude on behalf of both professionals AND the folks in pain.
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RE: One expert will lead to better care - June 25, 2008 9:49:13 PM
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bonez
Posts: 176
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quote:
ORIGINAL: SJBird55
Hold on proud... you need to pay attention to the full sentence, not just the aspect you want to be attuned.
quote:
In my opinion, it will be the consumers themselves that will weed out the practitioners that suck... but that will only happen as consumers experience different companies or practioners and only then will they know the difference.
In your example of the same chiropractor for years... the person hasn't experienced anything different to make any type of comparison.
The reason that costs are skyrocketing has to do with lack of professionals educating on pain and understanding pain; it has to do with a lazy society that would rather pop a pill versus be accountable; and it sometimes has to do with a "wait and see" kind of attitude on behalf of both professionals AND the folks in pain.
I think I have to agree here but I think it is more than just pain education. It is a quick breakdown on functional stability the role of exercise and the nature of repetitive activity. Also some responsibility for cost of care personally has an affect on motivation. Here we have some people swept up in government paid care and some who foot most of their bill. I have a hard time to get those who are paid for by the government to even do the easy stability work while those that are really paying will often go the extra mile with self care.
So those who don't work with trying to limit service will always have afield day with the socially supported crowd.
Not even all of those consumers will do the weeding. The patient has to be able to take responsibility for their problem. Living in a small community I am always suprised by the patient who graduates to self care active lifestyle who stops all the things that work because the girl at the next desk saw the craniosacral therapist and you know it did the moast amazing....... As a result word of mouth is important but testmonials for the FAR OUT always is trump.
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RE: One expert will lead to better care - June 26, 2008 3:12:19 PM
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jesspt
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From: Illinois
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I think Bonez hits on something interesting here. I've long thought that one of the primary resons for escalating health care costs is that in most situations here in the states there is virtually no financial burden placed upon the patient. How many of us have patients (many of whom swear up and down that they do NOT want surgery) who come to us having had an MRI? How valuable is that expensive medical test in driving conservative treatment? How many of those expensive tests do you think would get done if the patient had to pay for half of it? The health care consumer has long expected insurance to cover everything, despite the cost, and despite the efficiacy of the intervention or the utility of the test. And, for the most part, it has.
This attitude is actually fairly detrimental to the PT profession. The patient, who is not financially responsible for the expensive diagnostic testing, values the test far more than they value the therapy they recieve after the test, considering diagnostic testing necessary for an "accurate" diagnosis that will result in a better outcome. I wonder if that might change if more $$$$ were coming out of their pockets. Would they start to see that PTs are the bargain of the century?
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Jess Brown, PT
Board Certified in Orthopaedic Physical Therapy
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RE: One expert will lead to better care - June 26, 2008 6:22:18 PM
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SJBird55
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In my area, the policies have a greater out of pocket responsibility... there are higher deductibles and there is a higher frequency of co-pays. Michigan's state health plan and the teachers seem to have the least out of pocket expense. A lot of the BCBSM PPO plans in this area have deductibles but no co-pays.
What might be interesting is to have some sort of tiered financial responsibility - for example, $200 out of pocket for an MRI, $75 out of pocket for radiographs... in other words, the high end procedures could have a greater financial responsibility weight to them. I have had one patient who had a $40/visit for physical therapy AND initial evaluations were not a covered benefit. Go figure.
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RE: One expert will lead to better care - June 26, 2008 6:42:18 PM
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TexasOrtho
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I think politics has quite a lot to do with this SJ. How much political capital do you think we have compared to the radiologists? I agree mind you, but it's not that simple. Someone would have to decide the value of each intervention. Third party payors in various forms distort the concept of value IMO.
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Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: One expert will lead to better care - June 26, 2008 7:13:45 PM
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proud
Posts: 879
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quote:
ORIGINAL: jesspt
I think Bonez hits on something interesting here. I've long thought that one of the primary resons for escalating health care costs is that in most situations here in the states there is virtually no financial burden placed upon the patient. How many of us have patients (many of whom swear up and down that they do NOT want surgery) who come to us having had an MRI? How valuable is that expensive medical test in driving conservative treatment? How many of those expensive tests do you think would get done if the patient had to pay for half of it? The health care consumer has long expected insurance to cover everything, despite the cost, and despite the efficiacy of the intervention or the utility of the test. And, for the most part, it has.
This attitude is actually fairly detrimental to the PT profession. The patient, who is not financially responsible for the expensive diagnostic testing, values the test far more than they value the therapy they recieve after the test, considering diagnostic testing necessary for an "accurate" diagnosis that will result in a better outcome. I wonder if that might change if more $$$$ were coming out of their pockets. Would they start to see that PTs are the bargain of the century?
Well...take Canada for example. Universal Healthcare. No cost for MRI's etc. Yet, the public remains confused and dazled by sham treatments and the cost.... escalating. Interesting at all to our US counterparts? On top of that...MRI's are not nearly as readily available. Sometimes a 6 month wait so although many useless MRI's etc are taken( far too many)...the scale is markedly less then in the US.
I recall a statistic that stated that the US has more MRI machines in Philidalphia then all of Canada....
It's not about out of pocket expenses I'm afraid. Much more to do with a culture wherein people refuse to accept some level of responsibility for their own recovery. Someone....or something else is responsible to get me better. And there is tons of snakeoil salseman willing to suggest they can restore innate energy, re-align the cranial bones etc etc. At some point( mark my words) funding for that garbage is going to stop.
< Message edited by proud -- June 26, 2008 7:29:43 PM >
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RE: One expert will lead to better care - June 26, 2008 8:11:36 PM
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Sebastian Asselbergs
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From: Barrie, Canada
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Proud, I actually think your post could SUPPORT more out-of-pocket expenses. It can be argued that if we get a out-of-pocket amount each visit - i.e a co-pay - even for the "universal healthcare" patients (with certain limits and restrictions), I think we would see a much more judicious use of the service and possibly more compliance.
On the other hand: there are those with $10 co-pays who scoff at that amount, BUT have no trouble paying $125 an hour OUT OF POCKET for "cranial osteopathy" - once a week for 12 (!) weeks.
It may be that, no matter WHAT system is in place, there will abuses, poor compliance, and overbilling, as well as all the opposites.
I remember the Netherlands extremely complex system - with very similar complaints. Very restrictive coverage rules and coding, limited access for some groups, snake-oil galore.
Small of mind as I am, I just work hard to get my caseload to be self-limiting to those who are motivated, compliant and eager to learn, are happy to pay my charges because they are reasonable and not many (!). I will not see any substantial regulatory changes that will affect this style - which has been my experience, having gone through some serious changes in Ontario since 1986.....
The ONLY thing influencing my practice in a major way, has been MY learning and style of practice - not a government.
And maybe I AM in PT-paradise 
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Mundi vult decipi
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RE: One expert will lead to better care - June 26, 2008 8:23:15 PM
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proud
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quote:
On the other hand: there are those with $10 co-pays who scoff at that amount, BUT have no trouble paying $125 an hour OUT OF POCKET for "cranial osteopathy" - once a week for 12 (!) weeks.
Ta-da. People are always willing to pay for bizzare things. They love the eloborate explainations of "knots; within muscles, joints out of place etc etc...all bunk. Yet are not willing to pay for sound medical advice that places much of the onus of control on the patient.
Ever wonder why someone with "pain" is willing to pay 150$ for someone to place cucumbers on their eyes and hot rocks on their backs, yet scoff at a 300$ YEARLY gym membership?
And the crazy thing is that insurance pays for it( yes they do....if you go to a spa that has a massage "therapist".....it's covered.
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RE: One expert will lead to better care - June 27, 2008 6:48:10 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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quote:
Yet are not willing to pay for sound medical advice
A main problem is, and it brings us back to the "one expert", what defines "sound" for the patient? Who defines "sound advice"? It will require a lot more than regulation, a change in insurance pays, and PR; it will require a profound societal change in our communities. If Ben Stein can make a movie "Expelled" and can get real TV time again and again, there is still a HUGE part of the population that will continue to veer towards WHOEVER gives them that feeling of having "found" their own healer. Whether it is a CST-, MFR-, cranial osteopathic-, hot stone-, reiki-, or TT practitioner. Or the professional who has the biggest title, or the most famous clients, or the fanciest office....
Population groups have steadfastly ignored science over more Hollywood-style ideas of human healing and recovery. That is what I try to address, as I mention in the last paragraph of the previous post. On a small scale, since that is where I can actually do something.
I do not believe in more regulations. I come from the Netherlands - they invented regulation, AND dykes, since they found the enormous volumes of red tape caused the country to sink below the sea levels....
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RE: One expert will lead to better care - June 27, 2008 9:46:55 AM
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proud
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Sound advice:
1) LBP is rarely serious, stay active, exercise, do not rest for prolonged periods, and stay at work( some of the highest levels of evidence support this)
2) Consult the expert in NMSK differential diagnosis( Physiotherapist....wink). They can evaluate and ensure that nothing is ripped torn or broken, or in danger of doing so.( evidence supports early intervention by Physiotherapists)
3) The Physiotherapist can provide pain education( evidence supports this), re-assurance( evidence supports this), exercise advice( evidence supports this) and manual therapy if indicated to get that patient active more quickly.( evidence supports this...such as the manip CPR).
There is sound advice.
A large study was conducted from 2000 to 2003 and was published in the British Medical Journal ( Buchbinder 2005). In a community in Australia they ran television adds that stressed #1 above.
Remarkably, the study demonstrated that beleifs held about back pain became significantly more positive. More importantly, workers comp claims and medical payments for back pain declined sgnificantly! Compared to neighboring communities.
As it stands now....joe schmo goes to an ill-informed physican who tells him he likley has some degeneration and prescribes useless NSAID....Joe then goes out in search of something to help( a lost puppy sourounded by wolves ready to pounce). He finds him....a "practitioner" who takes an X-ray...tells him that "his spine is a mess and all these joints are out of place"...."it's pinching off his nerves".....
Joe Schmo is now a prime candiate to progress to disability as the script has been set into progress.
Jow Schmo has been duped. Joe schmo is now a patient for life....and the "practitioner" can buy his/her new boat.
THAT is why one expert that follows guidelines and evidence based appraoches is required.
< Message edited by proud -- June 27, 2008 10:22:06 AM >
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RE: One expert will lead to better care - June 27, 2008 10:50:48 AM
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proud
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No need to click the link....I know it. Funny. But that is the usual response when someone's back is up and they cannot defend their position( whatever that might be). No problem.
"long tracks"...how about a response that involves similair clinically relevant info....with simliar levels of evidence? Then we will see who shouild click the link.
< Message edited by proud -- June 27, 2008 10:58:50 AM >
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RE: One expert will lead to better care - June 27, 2008 11:26:20 AM
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Sebastian Asselbergs
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From: Barrie, Canada
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proud, you did not get my point. YOU know and I know there is sound advice and that we can give it.
We are not the ones who are in control of the funders, we are not the ones in control of the ministries, we are not the ones"deciding" what is sound and what is not.
We are not the ones who will the "big brother" telling everyone what they need to know or pay for. At least, I hope not.
We (or any other profession) can stand up and proclaim our right to the "expert" status and point at research - who'd listen? And why would they? The general population does not read the research in the first place....The decision making agencies do not look at that type of info either.
I maintain that we do best when we use our clinical approach with each individual patient, and do some lobbying there. And that takes time and patience.
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RE: One expert will lead to better care - June 27, 2008 11:56:12 AM
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proud
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No Seb, I do understand what you are saying.
But two questions:
1.) Do you disagree with anything I stated above?
2.) When you ask "why would they listen".....I submit that currently there is not much need as healthcare expenditure has not reached critical status. However...give it a few years( after the boom)....suddenly we are a top heavy society with less taxpayors and more healthcare depenadnt individuals. NOW....closer scrutiny will be required. Or do you think the skyrocketing NMSK conservative management can/should continue unabated? Do you not think that eventually, as insurance premiums reach unattainable levels for many, a certain level of restraint and scrutiny would naturally occur?
And I disagree with the notion that any profession can stand up and point to research. I would suggest that only Physiotherapy and Chiropractic would have a leg to stand on. Not massage, not osteopaths, not reikki therapists, etc etc.
If you can narrow the expert field down to one or two....then within those fields stiffer self-regulation would be required to mainatin at least a certain standard of adherance to the evidence( and it's not CST, MFR or the fabled "subluxation").....
< Message edited by proud -- June 27, 2008 12:41:19 PM >
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RE: One expert will lead to better care - June 27, 2008 3:49:07 PM
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Sebastian Asselbergs
Posts: 1117
Joined: September 29, 1999
From: Barrie, Canada
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I appreciate the train of thought; but the public is paying out of pocket for cranial osteopathy, naturopathy, homeopathy, reiki, therapeutic touch etc etc, already. Yes, there will be restrictions when the MSK trough gets empty, but - I must be a pessimist - I do not see that leading to any major changes.
Although I think that stiffer regulation as to what constitutes "within standards of practice" would be a major positive move, I remain pessimistic about the expected changes.
And your suggestion And I disagree with the notion that any profession can stand up and point to research. I would suggest that only Physiotherapy and Chiropractic would have a leg to stand on. Not massage, not osteopaths, not reikki therapists, etc etc.
is only correct if you look at research with a very critical and scientific eye. AND THAT is the problem; that perspective is NOT shared by a majority! Their view is NOT science-based. Not even the insurance companies with their adherence to the Quebec report (which was just poorly done science) has ANY clue to what science and GOOD studies really look like.
The problem is, that decision makers in any aspect of this issue are led by MORE (or rather: OTHER) than rational thought and science.
I do not disagree with you at all that the research favours the PTs and chiros, but alas - that is US looking at it (and I agree: it IS the right way)!
< Message edited by Sebastian Asselbergs -- June 27, 2008 3:54:45 PM >
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RE: One expert will lead to better care - June 27, 2008 4:11:28 PM
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rwillcott
Posts: 356
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From: Canada
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quote:
ORIGINAL: Sebastian Asselbergs
"I appreciate the train of thought; but the public is paying out of pocket for cranial osteopathy, naturopathy, homeopathy, reiki, therapeutic touch etc etc, already. "
People are not paying out of pocket for these services. There are PT's that are performing CST etc and billing insurance companies for manual therapy. Also, massage therapists are performing all sorts of alternative techniques that are being billed to insurance companies.
Some insurance companies actually lump physiotherapy and massage together! The patient has say $400 per year of massage and physio. How on earth did we get lumped in with massage under somoene's health plan?
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RE: One expert will lead to better care - June 27, 2008 9:06:40 PM
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proud
Posts: 879
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quote:
Some insurance companies actually lump physiotherapy and massage together! The patient has say $400 per year of massage and physio. How on earth did we get lumped in with massage under somoene's health plan?
HOW? simple:
1) Physiotherapists performing MFR/CST etc . In other words....letting their acedemic background down.
2) 6/10 Physio's practicing are ineffective and don't even know it( note: My guess only).
3) Horrid lobbying efforts and our own apathy( we could take a page from Chrio's there).
4) In canada, I have noted many new graduates are learning MFR and learning every PPIVM in the book...and have never heard the term clinical prediction rule, can barely define specificity or sensitivity, do not understand the iportance of reliability in our assesents, validity etc. Our acedemic institutions need to get it in gear.
In Canada...our own professional magazine( contact) has ads in it for John Barnes seminars I believe? hmmmm?
< Message edited by proud -- June 28, 2008 9:27:47 AM >
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RE: One expert will lead to better care - June 28, 2008 7:27:03 AM
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Sebastian Asselbergs
Posts: 1117
Joined: September 29, 1999
From: Barrie, Canada
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Willcott, that is simply NOT true as a generalisation "quote:
People are not paying out of pocket for these services. There are PT's that are performing CST etc and billing insurance companies for manual therapy. Also, massage therapists are performing all sorts of alternative techniques that are being billed to insurance companies. "
When you look at what you wrote about the amount of coverage and then look at the amount they pay per session of garbage-therapy (around 70-100 per hour) - which will last them maybe four to six sessions - you can see that they are pulled in to a trend of increasing out-of pocket expenses. And then there are the well-to-do here. They pay and pay and pay, no matter what their coverage was.
And then there is the naturopathy and homeopathy: NOT covered in most plans - yet a lot of $$ are spent out of pocket.
In the 25 years as a PT, I have seen the trend continue unchanged : the patient looks until they find some fancy explanation that "fits" and are willing to pay for for whatever.
I have at the moment about an average of 16 new patients a week: out of these, about 30% pay out of pocket. This is a self selecting system of course: they heard I do not treat 3xweek, 4weeks, and mostly teach people how to do it themselves, making me a cheap solution.....And it is from these that I hear their $3000 or $5000 expenses to all kinds of crap; they learned an expensive lesson. The best marketing I can do for PT - and it is very good for my business.
Proud, it is really sad, but those points all are correct - and it drives me nuts too, to see the MFR garbage ads financing our national Journal....(though I understand the finances of those things..)
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