Joined: March 23, 2006
what's left? Being one step ahead thanks to our affiliation with university and masters/DPT programs. By being one step ahead, we will eventually emerg as THE experts in the evaluation and management of all things MSK( provided we eliminate the dinousour modality based clinics and the clinicians who treat with "mystical' techniques such as CST.)
NOTE: We still use modalities...we just know WHEN to use them.
NOTE: we do manipulation...we just know WHEN, and more importantly when not to manipulate. If anything Chiro's are LOOSING control of manipulation and recognizing that we had it right all along...manipulate some, mobilize some, stabilize some etc.
NOTE: We can do massage...as part of a rehabilitative program and not as a singular technique.
Everytime a profession discovers through research that a concept may be false and abandons it to move forward, another trade will fill the void until the technique fades away( I think osteopaths started out as spinal manipulators only and recognized the fault...void filled by unknowing chiro's...now many chiro's recognize the need to expand).
Keep up with the research and we/you will be just fine.
" An OTR or LOT is responsible for developing and modifying the patient's treatment plan. The treatment plan must include the following components: goals, interventions/modalities, frequency, and duration. "
This section is pretty much different from the California OT Practice Act
which stated specifically the following with regards to modalities:
2570.2. (l) "Hand therapy" is the art and science of rehabilitation of the hand, wrist, and forearm requiring comprehensive knowledge of the upper extremity and specialized skills in assessment and treatment to prevent dysfunction, restore function, or reverse the advancement of pathology. This definition is not intended to prevent an occupational therapist practicing hand therapy from providing other occupational therapy services authorized under this act in conjunction with hand therapy. (m) "Physical agent modalities" means techniques that produce a response in soft tissue through the use of light, water, temperature, sound, or electricity. These techniques are used as adjunctive methods in conjunction with, or in immediate preparation for, occupational therapy services.
2570.3. (d) An occupational therapist may provide advanced practices if the therapist has the knowledge, skill, and ability to do so and has demonstrated to the satisfaction of the board that he or she has met educational training and competency requirements. These advanced practices include the following: (1) Hand therapy. (2) The use of physical agent modalities. (3) Swallowing assessment, evaluation, or intervention.
(e) An occupational therapist providing hand therapy services shall demonstrate to the satisfaction of the board that he or she has completed post professional education and training in all of the following areas: (1) Anatomy of the upper extremity and how it is altered by pathology. (2) Histology as it relates to tissue healing and the effects of immobilization and mobilization on connective tissue. (3) Muscle, sensory, vascular, and connective tissue physiology. (4) Kinesiology of the upper extremity, such as biomechanical principles of pulleys, intrinsic and extrinsic muscle function, internal forces of muscles, and the effects of external forces. (5) The effects of temperature and electrical currents on nerve and connective tissue. (6) Surgical procedures of the upper extremity and their postoperative course.
(f) An occupational therapist using physical agent modalities shall demonstrate to the satisfaction of the board that he or she has completed post professional education and training in all of the following areas: (1) Anatomy and physiology of muscle, sensory, vascular, and connective tissue in response to the application of physical agent modalities. (2) Principles of chemistry and physics related to the selected modality. (3) Physiological, neurophysiological, and electrophysiological changes that occur as a result of the application of a modality. (4) Guidelines for the preparation of the patient, including education about the process and possible outcomes of treatment. (5) Safety rules and precautions related to the selected modality. (6) Methods for documenting immediate and long-term effects of treatment. (7) Characteristics of the equipment, including safe operation, adjustment, indications of malfunction, and care.
(g) An occupational therapist in the process of achieving the education, training, and competency requirements established by the board for providing hand therapy or using physical agent modalities may practice these techniques under the supervision of an occupational therapist who has already met the requirements established by the board, a physical therapist, or a physician and surgeon.
(h) The board shall develop and adopt regulations regarding the educational training and competency requirements for advanced practices in collaboration with the Speech-Language Pathology and Audiology Board, the Board of Registered Nursing, and the Physical Therapy Board of California.
Joined: July 31, 2005
Cyril and others,
As I have mentioned before, there is no such thing as billing for "physical therapy". In fact, other than the PT Eval codes, there are no codes that I know of specific to PTs. There are physical medicine codes like US, estim, manual therapy, etc. Depending on the state and the insurance company, chiros can and do perform these services and are reimbursed.
Also, like I've said earlier, many of these modalites were being taught in chiro college before the PT profession ever existed in the USA. As early as 1908-ish, chiro colleges were teaching rehab, electrotherapy, etc.
I'm not mentioning this to argue with any of you, but I wanted to be aware of these facts.
Joined: March 21, 2006
I think that's absolutely frightening. 5 hours is clearly not enough time to teach the use of modalities.
Don't get me wrong, they're quite easy to use. A monkey could perform an ultrasound. However, it's the professional who practices with EBM who would know when to use ultrasound and when not to use it.
How about a patient with AC joint pain for the past 2 months. An aid or OT with 5 hours training decides to ultrasound the region. Oops! I forgot to check red flags. The patient has had night sweats and night pain that wakes them consistently from their sleep. Oh, it's just a pancoast tumor that I've been ulrasounding for the past month.
Joined: November 15, 2003
Rob, Bas, Proud..
Precisely. If the neurologists are said to be in pain management (I can't really understand that statement) then it is high time all PTs were into pain management. They are to a fair degree in the UK, Canada, Australia, for starters. It has a huge potential for a PT career and one that could keep us all busy and happy for years to come.
It doesn't need a masters or PhD; it just needs reading and understanding basic principles of pain physiology. I may be misunderstanding the USA way of billing and ordering of treatments; it is way too complex to figure out anyway.
Joined: March 23, 2006
Good point about upper extremity and neck. Physiotherapists are truly the experts in MSK management, high time this fact is recognized and implemented as a healthcare policy to control cost and patient outcomes.
For example: If a patient has back pain, why see a chiro for manipulation( cost ? 75$), a massage guy( ?cost 75$), and a PT for stability work( ?cost 50$)...when PT can deliver the care under one roof...more effectively, with less confusion to the client, and with less overall cost. With EBP emerging, I think that time is coming.
Joined: April 25, 2004
From: Amherst, WI
The broad brush of OTs (versus a specific OT) is likely unhelpful and deferring to the old saw of ""OTs don't treat the neck" is also. I see PTs use that line of reasoning to try to contain OTs routinely. It's like chiropractors suggesting we can't manipulate. The only thing that's worse than that, in my opinion, are the OTs that just accept it. Contemporary OT education gives those professionals the ability to understand and treat the neck as they find it relevant.
Joined: July 31, 2005
I'd be rich if I were getting $75 per adjustment! Wait, are those Canandian dollars? If so, then that might be feasible, but I only get between $28-$35 for an adjustment. Then, another $25 for manual therapy, $25 for rehab, and if I use passive modalities-$12-15.
EB PTs and Chiros are the best way to cut healthcare costs for NMS conditions. A DPT I know and myself average about 8 visits per condition (excluding post surgical and more severe injury). The non EB PTs and DCs in our area probably averages 20+ visits for all conditions.
Joined: March 23, 2006
Buddy T DC,
Yes, I do not know the billing info in the US for Chiro.
I do think EB Chiro's provide effective management. True. But it is a hard sell for two reasons:
1.) No university affiliation...thus psuedo-science can continue to thrive within the teachings.
2.) Many Chiro's continue to practice with complete disregard for EBP. As long as that culture continues to exist, and all PT programs become DPT( in US and Canada etc), It becomes an even harder sell.
Is that a fair analysis? Not trying to stir the pot on that. But what are your thoughts on that Buddy T DC?
And Jon, I think OT's are well trained, but you would have a hard time convincing me that they have as intimate a knowledge of the potential multi-factorial causes of shoulder pain as a PT.
Joined: September 14, 2002
[QUOTE] As I have mentioned before, there is no such thing as billing for "physical therapy". In fact, other than the PT Eval codes, there are no codes that I know of specific to PTs. [/QUOTE]True, true, true. Now why then do the majority of chiros feel they need to call the modalities they perform and/or advertise it as physical therapy?
[QUOTE]Also, like I've said earlier, many of these modalites were being taught in chiro college before the PT profession ever existed in the USA. [/QUOTE]Link, please?
IMO modalities are old hat and the evidence suggests for the most part they are not effective other than placebo effects or acute conditions. So why all the fuss over modalities, our profession is moving forward and for the most part leaving the modalities or as chiros call them physical therapy behind.
Joined: July 31, 2005
I don't own the book, but I believe the title was something along the lines of "The History of Chiropractic Education in the United States". In that book it states that when a DC/MD broke away from the Palmer college, he opened his own called National College, where he strengthened the basic science education and added other interventions such as hot/cold therapy, electrotherapy, and exercise therapy. This happened in 1906 or 1908. I dont mention that to try and take ownership of modalities, but some here have suggested that only recently chiros have been adding rehab and therapies. Not the case.
Yes, you are correct with your assessment. No university affiliation is a major problem, especially with some of the straight colleges. The other colleges are doing a pretty good job, but they could do better if they were affiliated with more hospitals and had a better clinical experience for us. My school, NYCC, is beginning to do much better in that area as they have students rotating through Bethesda Naval Hospital, Camp LeJeuene Medical Center, Clifton Springs Hospital in upstate NY, one or two VA Hospitals, and a few others. A long way to go, but a good start.
Even so, all of that is a moot point. As long as a chiro practices according to the evidence and does a good job, they will have no worries. We will receive our fair share of referrals not from MDs, but from our patients. I am quite busy in my second year and I have not received one referral from an MD. Not one. Even though I try to integrate and play nice (having lunch with them, sending reports, etc.), it's obvious to me that I will have to work outside of the system. I dont mind it. As long as I get results and don't waste people's time or money, I think I will be ok.
In terms of healthcare costs(going back to the tangent we went off on), insurance companies should start to be more picky with the providers they allow in network. The more clinically and cost effective providers should be rewarded and kept in network, while everyone else booted. ACN is doing this to a certain extent, but I don't think they are doing it correctly. They are basing it purely on visit numbers and not outcomes. We need someone to do it based on outcomes and overall cost of managing someone's condition. I have no idea how we would do that, but it would be nice if we could.
Joined: July 31, 2005
Oh, I didnt address why some chiros call modalities physical therapy. Mostly it is out of ignorance. They dont know any better. It's therapy and it's physical in nature. For others it is used to be deceptive. I've been told to call all of those procedures "physical medicine' instead of anything remotely close to physical therapy or physiotherapy. Usually I'll describe what I do as physical rehab, manual therapy, and therapeutic modalities. How does that sound?
Joined: March 23, 2006
Buddy T DC,
Thank you. I do think that the provider who offers the best outcomes should prevail. However, this is very difficult for third party payers to do... Evaluate clinicians on an individual basis( I am assuming your clientle, although not referred by an MD, have insurance which you bill?).
Just my opinion, but I figure the path we are heading down is third party payers determining what "type of clinician" rather than individual clinician( PT, Chiro, Massage, Reikki master, whatever) they are willing to pay for...what profession has the most solid evidence to back up what they do. With an aging population( baby boomers), the burden on healthcare systems will be large. Controlling skyrocketing cost will be a big issue I figure by 2012...What provider will be positioned to provide the evidence? PT is already emerging as that provider. We have a long way to go but all the ducks are in a row so to speak.
This is why I harp on my own profession about performing "alternative" treatments( cst etc). Because I do not want to be represented that way when the chips fall. And I figure Chiro will have a hard time when the crunch comes due to a lack of university affiliation( This is why I figure this is high on chiro's agenda?). But given the "foundation" of Chiro, I don't see how university affiliation can happen.