Tuesday, February 24, 2009

I don't like Ed Towns

Oppose Legislation HR 1137 That Will Weaken Qualification Standards for Personnel Providing Physical Therapy Services in Physician Offices

On Monday, February 23, Congressman Edolphus “Ed” Towns (D-NY) introduced HR 1137. This legislation would overturn the current Medicare “incident-to” rule and recognize athletic trainers as covered providers under Medicare. Please contact your Member of Congress today and ask him/her to OPPOSE this legislation!
APTA strongly opposes this legislation (HR 1137) and supports Medicare’s ability to require qualification standards for therapy services provided “incident to” a physician’s professional services. It is the position of the American Physical Therapy Association (APTA) that physical therapists are the qualified professionals who provide physical therapy examinations, evaluations, diagnoses, prognoses, and interventions. Interventions should be represented and reimbursed as physical therapy only when performed by a physical therapist or by a physical therapist assistant under the direction and supervision of a physical therapist.
In November 2004, the Centers for Medicare and Medicaid Services (CMS) included provisions in the final rule for the 2005 Medicare physician fee schedule that established qualifications and clinical preparation standards for individuals who provide physical therapy services “incident to” a physician’s professional services. These provisions implement requirements adopted by Congress in 1997 to protect patient safety, ensure the appropriate use of Medicare resources, and guarantee the delivery of physical therapy services by qualified physical therapists. Opponents of these regulations were unsuccessful in their attempts to have CMS rescind the rule implemented in May 2005. These organizations also filed a federal lawsuit attempting to force their withdrawal, and a US Court of Appeals upheld a district court decision dismissing the litigation.
Talking Points
Patient Safety - HR 1137 jeopardizes the health, safety and welfare of Medicare beneficiaries by allowing non-qualified individuals to provide therapy services. The “incident to” regulations standardize existing Medicare requirements that physical therapy services must be delivered by qualified personnel in all outpatient settings. There is no evidence that these standards have restricted the delivery of physical therapy in physician offices. Without enforcement of appropriate qualification standards, it would be impossible to ensure that Medicare beneficiaries receive and the Medicare program pays for an appropriate level of safe and effective care delivered by an individual qualified to provide physical therapy.
Cost-effectiveness – HR 1137 is fiscally irresponsible and will cost taxpayers due to inappropriate billing of therapy services by non-qualified individuals. In a report issued in May 2006, the Office of Inspector General (OIG) of the Department of Health and Human Services found that 91% of physical therapy services billed by physicians under the old “incident to” rules in the first 6 months of 2002 failed to meet program requirements, resulting in improper Medicare payments of $136 million. The Inspector General found that the total payments for physical therapy claims from physicians skyrocketed from $353 million in 2002 to $509 million in 2004, and that the number of physicians billing the program for more than $1 million in physical therapy more than doubled in that two-year period.
This follows a report done in 1994 by the OIG that estimated that more than $47 million in unnecessary therapy services were delivered in physician offices under the old “incident to” rules. As a result of the 1994 report, Congress passed the Outpatient Physical Therapy Standards Act of 1997 as part of the Balanced Budget Act. This legislation established a standard for physical therapy delivered in a physician’s office consistent with that in all other outpatient settings, and the regulations promulgated by CMS in 2004 implement these standards in keeping with the intent of Congress.
Quality Care – HR 1137 dilutes the quality of care for Medicare beneficiaries by allowing non-qualified individuals to deliver therapy services. Medicare beneficiaries deserve a consistent standard of care that ensures that providers who deliver these services have attained the level of education and qualification necessary to provide them safely and effectively. Without appropriate personnel standards for individuals delivering highly skilled and recognized Medicare services such as physical therapy, the standard of quality is jeopardized.
What You Can Do
Contact your House Representative and ask them to OPPOSE HR 1137 TODAY!
CALL: Contact your House Representative by calling by calling the Capitol switchboard at 202/224-3121. Remember to ask to speak with the Health Legislative Assistant and ask your House Representative to OPPOSE HR 1137.
EMAIL: Visit www.apta.org/advocacy and click on the Legislative Action Center to send an email to your House Representative.

Monday, February 23, 2009

Blog Roll

I have not updated my links on the right side over there in a long while -->

So here is the easier way for me to update all this, these are the PT relevant (plus a few other fun) websites I follow using either Blogger (through this blog) or through Google Reader (RSS feed reader):

My Top Picks in no particular order:

1a) Exercise-ology
1b) View from Sports Center (not related to ESPN)

2) Mike Reinold

3) Seth Godin

4) Street Anatomy

5) TED blog

6) where I work... not a blog

7) One of the best PT practices I have had the pleasure of associating with

8) A Day in the life of a PT student

9) "The future of manual physical therapy is in your hands"

10) Clinical Reflections

11) Some of the discussion boards on MyPhysicalTherapySpace.com


13) Neurotonics

14) NPA Think Tank

15) Physiopedia

16) Orthopedic PT

The Top Health Blogger himself Tim Richardson
17a) PT Diagnosis
17b) Bulletproof PT

18) PT Rover - nothing new in a while...

19) Physio Info-blog - also not much in a while...

20) Physiospot Musculoskeletal

21) Rehabcare blog

22) Medical News Today -> Rehab & PT

23) SCI Info News Blog - any of the latest breaking news on SCI

24) PT Etcetera Blog

25) Sports Injury Clinic - Research - seems to be something wrong with the RSS feed, because they have recent articles but it doesnt get sent to my RSS for some reason :(

26) Toni Talks about PT Today - is it just me or does Toni seem very bitter and cynical in all of her posts

27) http://twitter.com/babenkoe - and all the other wonderful PT tweeters out there...

28) (Un)edited Tales - she has even less PT content than me, but she also seems to be in NYC so the food suggestions are very useful

29) Moving Forward

30) Rookie PT

31) S.46: Medicare Access to Rehab Services Act of 2009 - the best part is the "111st Congress" - they didnt notice the need to change it to 111th

Any I missed (it wasn't on purpose)? Please share!

Bike V02 Max Test

This is a seemingly great explanation of the V02 max testing.

*Not me in the picture above, but very similar setup with the same mask and livestrong bracelet...

I got my test in this morning before work, so I probably did not go to my "max" as one should for most accurate readings. But I wanted to be able to walk around at work. My numbers were very comparable to the running test I did back in October before the ACL surgery. The V02 max was about 49, which equates to a 53-ish with the running, which is where I was, and max HR was 168. The problem was my carbon dioxide I was breathing out never crossed the oxygen I was breathing in (at least the levels didn't on the graph, they physically had to have crossed). For that reason, I will be re-taking it next Monday, perhaps I will videotape it for your viewing pleasure. Also, this test was a 25 watt interval, meaning every minute the resistance went up by 25 watts, whereas because I displayed some steady vitals the test may be more accurate with a 50 watt protocol, meaning I reach my "runnin' on fumes" phase much quicker.

I am excited to continue strengthening my quads, and use this type of data to utilize my training as I begin to cycle and swim much more.

Educata Continuing Ed.

I was passed on this blog tip for continuing education, the list of their faculty is a pretty darn impressive who's who in the PT world. The opening line to the e-mail made me smile so I thought I would share:
I enjoy reading your BLOG -- and your out-of-the-box perspectives. Fun!
Thanks Monica!

By way of introduction, EDUCATA (
www.educata.com) had its public debut earlier this year, to rave success. There are reasons why it stands out:
- Top-of-the-line educators (you may know some of them, actually, as they routinely speak at PT conferences)
- Strength of the technology platform, which is fully interactive (visuals, video, audio; pause-resume capabilities; baseline knowledge test at start of course; evidence of learning at exit at end of course; ability to interact with the instructor; certificate vaulting; courses in increments of 1 contact hour and up; etc.)
- Accreditation with the licensing boards of most states where CEUs are required

There is also a press release that was sent to me which is in .pdf format. I wanted to share through GoogleDocs but that would require that you have a Google account and I send you the invite to the .pdf... which is kind of silly, but I understand not allowing sharing of any and all .pdf's... I think?

The press release should actually be on the website tomorrow, but Adobe does let me copy and paste text, so here goes (it looks a lot better via .pdf

Page 1 of 2
For press inquiries, contact:
WCPT: Brenda J Myers, Secretary General
+44 (0)207 471 6765
EDUCATA: Monica Berndt -- Marketing
+1 323-256-1855
EDUCATA and the World Confederation for Physical Therapy Partner to Provide First Global Online Continuing Education For Physical Therapists
Interactive Web 2.0 platform brings latest education and technology to physical therapists around the world
(Calabasas, Calif. February 24, 2009)— The World Confederation for Physical Therapy (WCPT) and EDUCATA, the first company to offer a global continuing education platform for physical therapists, have partnered to provide online courses starting in February, 2009. The WCPT is an international professional organization whose members are national physical therapy associations.
“We believe that there is a tremendous need for physical therapists around the world to stay current on the latest advances and have convenient access to educational opportunities for ongoing professional improvement,” said WCPT President Marilyn Moffat, PT, DPT, PhD, FAPTA, CSCS. “In many countries, costs and distance barriers make it very difficult for therapists to get access to ongoing training and education.
Educata brings this vital educational experience directly to the physical therapist online,
wherever and whenever it is convenient, at a reasonable cost.”
EDUCATA Co-Founder/CEO Marilyn Pink, PT, PhD said, “We’re honored to work with the WCPT to make continuing education available and feasible for physical therapists globally. Our goal is to raise the bar in the international arena for evidencebased clinical practice.”
Page 2 of 2
Dr. Pink, who has over 20 years of experience in healthcare and sports medicine as a clinician, educator, scientist and businesswoman, says that Educata was created to give physical therapists knowledge to enhance patient/client interventions through a cutting-edge technology platform that is user-friendly, convenient and low cost. Also the founder of a web, evidence-based healthcare and fitness company, Dr. Pink has published and presented over 150 peer-reviewed articles and international lectures on managerial, clinical and scientific topics.
EDUCATA Co-Founder/CFO Michael Weinper, PT, MPH, has over 35 years of experience and expertise in clinical practice, management, consulting, administration and program development. He is founder and principal in Progressive Physical Therapy, a private practice therapy group with five locations, and founder of Physical Therapy Provider Network (PTPN), the first specialty managed care organization in the preferred provider organization (PPO) environment with networks in 23 states.
EDUCATA offers a broad spectrum of courses covering the areas of orthopedics and cardiovascular/pulmonary to geriatrics and oncology that are taught by top-ranked educators and experienced clinicians who are researchers, authors and instructors at professional scientific conferences. It combines visuals, audio and video, and other interactive technology to provide a rich, highly engaging learning environment.
About Educata: Educata.com is a unique, interactive, Web 2.0 continuing education platform that delivers online learning for health professionals. Physical therapists and other medical professionals are the focus of the first launch. Subsequent launches will target additional professions requiring continuing education. To find out more about EDUCATA, go to www.educata.com or contact Dr. Marilyn Pink at 805-495-7477.
About World Confederation for Physical Therapy: The World Confederation for Physical Therapy (WCPT) is an international non-profit professional organization founded in 1951. WCPT is a confederation of national physical therapy associations supported by subscriptions from its 101 member organizations and through them it represents over 300,000 physical therapists worldwide. For more information about WCPT, email info@wcpt.org or visit http://www.wcpt.org/.

Follow Me


in case you didnt have enough stuff to read and follow...

web 2.0, gotta love it (strike that - anyone know how to do that on blogger?), gotta keep up with it

Attempted Bike Vlog

This did not turn out that well... next time I will have to not be on the bike... I also recorded the rest of the 2.5 mile boardwalk ride... its quite scenic. I figure it will be very different soon, and it is a very beautiful route... I will get that video up whenever it finishes uploading... tick tock

Street Anatomy

They have a great blog that I always enjoy checking out... here is an addition for them from the streets of nyc

Sunday, February 22, 2009

Another Lazy Sunday

Got about 4 hours of biking in yesteday, very leisure like. I was going to go swim today, but decided to rest up for my V02 bike test tomorrow. This will be a big test for my endurance since I have not been going too hard in training yet. The knee is feeling much better, at about 9 weeks I had my first experience of descending stairs without pain.
Preparing a little for one of our mock evals tomorrow that we do every monday, we will be thoroughly reviewing the shoulder. Exams, normative values, etc. Interventions to follow.
Also, in putting together a presentation on spinal manipulation, I found this great guest editorial in JOSPT with this answer as to what to tell a patient when they ask why spinal manipulation therapy worked:

...the spinal manipulation caused transient and widespread forces to be
absorbed through the treated area. These forces produced a barrage of input into
the nervous system, evoking responses between the spinal cord and the cortex. A
likely explanation for the successful outcomes achieved in this particular
patient could be pain inhibition and changes in motneuron pool activity,
although non-specific effects due to placebo and patient expectation could not
be ruled out.

Tuesday, February 17, 2009

PT in the NYTimes

Check out todays Science Times with Physical Therapy and the Camaraderie of Healing
one step closer to helping our health care system... hopefully...

Saturday, February 14, 2009

Post Op Week 8 and 1 Day, aka VD

Happy Valentines Day ya'll (watched Friday Night Lights recently, hence the "ya'll" - great show though)

Another bike ride today, here are times:
3:50 - house to boardwalk (BW) warm-up
12:10 (8:20) - 2.5 miles of BW - had a pretty strong backwind, felt great
24:20 (12:10) - 2.5 miles back - had to fight that wind that helped me get an 8:20, twas a good challenge
27:54 (3:54) - cool down

Total distance: 6.27 miles (10.09 km for the rest of the world :)

I am trying to set up a V02 max bike test so that I can really start training properly. I still have my big old clunky mountain bike. I want to start taking some pictures and video of all this fun stuff to share with you guys... the tearing down of Coney Island is a sad reminder on every ride though, there are a ton of blogs covering it (here is just one), but sad to see every time out there, it's still a beautiful ride.

Tomorrow I will try to go swimming for the first time... I went in a hot tub when I visited Atlantic City last weekend, and while it was relaxing, all that heat is not great for the knee...

Now on to clinical thoughts, the actual original intent of this blog!

This past week my case load grew quite a bit which is always great for stability and my own comfort, rather than just jumping around picking up random patients from other therapists. Got to see an orthotic evaluation including the mold of the feet being made, they get shipped out to the company that makes the orthotics and the patient gets support and improved function just like that, it's a beautiful process (minus the foot smell, just kidding).

A main point that keeps coming up and I think is a common issue with many newer practitioners is "too much versus too little". Coming out of school you have a million different possibilities in mind, and often times you want to screen for every one of them and other times you may not screen enough and end up missing something. There is a fine balance with huge implications on the time you have in the day. Also pushing a patient through an extra set or few reps versus not challenging the muscles enough, the balance of good vs. bad pain vs. soreness. This all requires the most intricate of understandings of muscle physiology, periodization of training, healing response, that person's psychological profile, among other things. Even typing this gets me excited about the job I get to do every day... I wish I was a little more eloquent with my vernacular most days, but I hope my passion for the human body and all the musculoskeletal stuff going on comes through to you... all that heart, lungs, bowel stuff, just not as exciting.

Speaking of passion for PT, check out this blog from India:

Lastly, I am pretty upset I did not get to go to Las Vegas for the Combined Sections Meeting of the APTA, I hear it was a pretty amazing conference with tons of learning and fun... I am gonna try not to miss too many more, so hopefully no more surgeries for me :(

hope you didn't pay too much for those roses today... i paid $5 a rose... got them for my momma

Saturday, February 7, 2009

Post-Op 7 weeks 1 day

Just rode my bike on the boardwalk for the first time since the surgery and it felt great despite (maybe because of) the sub 45 degree weather. I get such a great quad workout on my mountain bike, with high resistance most of the way. Eventually I may take up actual cycling with one of those super light bikes that go real real fast, it seems like a bit of fun. So here is my own times for today for record keeping.

5 - warm up lap around my neighborhood that led me back to my house to get gloves and a neck warmer (smart call)
3 - time from house to boardwalk
12:40 - length of boardwalk (2.5 miles)
10:00 - roundtrip of boardwalk (another 2.5 miles, was going down wind)
3:40 - cool down in neighborhood to get back to house including intermittent backwards pedaling

I am really motivated to start getting more steady workouts in as well as a solid amount of article reading, topic prep for the near future. We have one particular student at the clinic I am collaborating with to present the latest on core training and manipulation for low back pain, with two other clinicians presenting on the medical/surgical side of things. Should be fun. Have a healthy weekend people :)