Joined: October 27, 2002
From: New York, NY
Where I teach the OTs get a fair amount of content on E-Stim. Not nearly to the level that I teach it in our program but an adequate amount nonetheless.
To be honest, I teach my students all about the waveform parameters, estim physiology and the related resarch. When they go to clinic however, the CIs usually don't know that much and just pick a button on the machine and turn it on. Try asking your local PT to describe the typical waveform used in TENS.
Why focus so much on this issue? The real issue is the fraudulent practices of your facility. You are worried about encroachment while your license is on the line with these unethical mandates.
In Healthcare, there is encroachment and competition from all quarters....always. You may be feeling the squeeze....but so is everyone else in healthcare. Just ask your local primary doc what his/her day is like.
We can rise above the competition by doing what we do......and doing it well. The field has moved forward tremendously and has thus encountered a lot of resistance. Expect and embrace competition.
Joined: July 31, 2005
Yes, about 90% of the people I see do use insurance.
And I dont know about payers choosing a certain type of provider versus individuals. If they did, I'm not so sure they would just choose PT and leave out chiro. Like I showed you in an earlier post, plans that include chiro benefits lower costs. That's not just manipulation, but it's management by chiropractor from beginnning to end. Once PTs are fully direct access and get paid for it (without any need for physician referral), I think they'll find that PTs lower costs too.
The origins of chiropractic will have little to do with a payers choice to include it in the plan. They will do whatever they can do to save money. Plus, state laws come into play too. In my state, if a plan pays a PT to perform manual therapy, they must pay me if I perform it and bill for it. Same with exams. If a plan pays an MD to examine someone, then they must pay me for those same codes. They cannot discriminate.
The other thing in all of this what health insurance consumers want. Chiropractic care is not included in insurance plans for the heck of it. People demanded it. If PT was dropped, people would demand that too. Dont forget about the customers. Insurance companies are selling a product, and they need to make this product attractive to people.
Joined: March 23, 2006
Buddy T DC,
1.)I read through many of the articles you posted. I think it is noteworthy to point out that many if not most of them are Chiropractic "journals" and articles written by a chiropractor( I think I did see the Annals of intern med and BMJ once). Having said that, I personally think that a good EB chiro likely does provide cost effective outcomes.
2.) As it stands now, you are correct about third party payors and state law. However I am speaking about what I figure the future holds. Currently, from what I see, DC's have managed to gain significant political pull. I figure with ongoing scrutiny, that political pull may very well shrink.
3.)Consumer choice: I made this argument in a previous posts about letting the consumer choose what is covered in a plan. That makes no sense, and it never has. Where is the literature that supports massage as a cost effective and long term solution to LBP? Yet it gets covered? The reason is exactly what you have stated...the consumer's choose it. It "feels good". But just because it "feels good" does that mean my premuims should skyrocket to let someone go for a rub to "feel good". Heck, why not just cover the cost for a day at the spa for some hot rocks and cucumbers on your eyes...
Maybe not at this moment...but soon, third party payers, political interests etc,will have to become more responsible to the bottom line. Like I said, I figure the ground work is already being laid. By 2012, we may see a whole new healthcare atmosphere in the MSK arena.
Joined: September 14, 2002
[QUOTE] 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? [/QUOTE]Buddy,
That's sounds good, I wish there were more out there like you.
Joined: March 29, 2003
Proud posts: DC schools have.... [QUOTE]1.) No university affiliation...thus psuedo-science can continue to thrive within the teachings. [/QUOTE]Most(if not all) non-US/Canada DC schools are university affiliated.
It doesn't appear that "university affiliation" has made PT impervious to "psuedo-science".
Joined: March 23, 2006
I always wondered why Chiro seemed to be more acceptable outside of North America. I guess that might be the reason.
And you are correct about some PT's still performing "psuedo-science". If you notice from most of my posts, nothing gets me going more than psuedo-science PT's. How you can graduate from a university and practice in that manner is beyond me.
I have even gone so far as to call for a professional committee to do away with this garbage once and for all. Not vert popular, I gather.
I do have a theory however. I think with our current system which allows the consumer to select what gets covered, has resulted in "trickery" and "fancy" items to capture the interest of the unassuming public. Chiropractors have historically been awsome at that( what are those thermal indicators some use????). Result: in order to compete, some unfortunate PT's found various "fantasy" treatments as well to capture the public's attention. And low and behold, the poor public has been left holding the tab with an epidemic of MSK pain. But where did the science go??? It is just starting to return over the past 5-6 years, and just in time.
Jeep, regardless of those facts, when the big picture is taken( coming soon to a theater near you), the university affiliation in North America will stand out in the eyes of the EB model. And those unfortunate PT's you speak of will also feel the pinch, justifiably so...
Joined: March 21, 2006
Presently, patients walk into their doctor's office and state what they want. If they walk in and ask for massage, the doctor writes a prescirption for massage. So part of the problem lies in the hands of the Physicians. Many of them are not familiar with any research in MSK issues.
I know here in Canada PT has become a direct access profession. Meaning you do not need a Physician's referral to see a PT. However, if you want your insurance company to pay for it you reuire a referral. I think this is the problem.
There is no reason why a patient can't enter my office with back pain without seeing their doctor first. It means the patient is being seen faster and stops any unnecessary testing (i.e. x-rays, nerve conduction velocity tests etc.)
My impression is that PT's as a group do not do enough to promote our profession. There is so much we should be doing and are not.
Joined: February 12, 2005
"Contemporary OT education gives those professionals the ability to understand and treat the neck as they find it relevant."
...that's beautiful Jon.
I think that statement needed to be said. Not for OTs sake so much as for the "Allied Health" professions.
I think we at times forget the collective nature of what we do. We all treat people and not parts and some of us quickly get sidelined with the how and not the why. This truly serves no ones purpose. We all graduate with a solid background in anatomy, biomechanics, electrotherapy etc. It is the education beyond school (Cont. Ed) and the practice and mistakes that furthers our skills.
Few of us (PT or OT) ever achieve "master clinician" status mainly for the fact that the average career span of a therapist is 6-8 years. Perhaps Cyril good take the time to in-service her staff; PT, PTA, OT and COTA on any new updates on electrotherapy if she personally finds that a valuable and worthwhile treatment to spend with her patient population and perhaps better benefit the patients, the allied health team and the facility.
The crossover in these professions and others like Chiro, Athletic Training etc is here to stay. It is no suprise that you may find all the services in a particular facility provided by one profession and the total opposite in the facility down the road. This "allied health" field is fun and fascinating because of the diversity and the chance to always reinvent ourselves. We will always have OTs and PTs collectively and effectively providing orthotic services, seating and positioning services, ergononics, aquatics, mobility programs, assitive technology, musculoskeletal/orthopedic services etc. The body is not divided among professions nor is our practice patterns.