Saturday, June 28, 2008

Forget 2020...How about Vision 2008?

I know we are all fired up about the utopia that will be 2020, but it might be a good time to take an honest look at the here-and-now.

The Good

I am amazed at some of the pessimism and complaining that runs rampant in our profession. I think some of this general crankiness comes from a serious lack of perspective. Firstly, we now generate more relevant clinical research not only in our own journals, but in many well-respected journals of the medical profession. Secondly, despite relevant misgivings about the current state of our education and training, we are arguably kicking out more well-rounded and academically prepared therapists into the work force. Lastly, although I hear PT's complain about their pay entirely too much, salaries have never been higher. Basically there has never been a better time to be a physical therapist and we are doing some things very well.

The Bad

At the same time, we do have our share of important issues to deal with. Reimbursement is declining across the board. Regulation of our practice (guided by the flagship CMS) is at an all time high. While innovation is being championed in the form of inspiring new clinical research, emerging and potentially useful practice patterns are too often fractured by suffocating reimbursement and regulatory guidelines. To whom should we cast the first stone?
  • Ourselves in not policing our practice patterns when the money was good.

    Thanks to our gluttonous billing patterns of yesteryear (Can you say "HUMing?), we are currently paying the price. Everyone was doing it it's ok right? Right.

  • Third party payors in realizing they could actually make more money by regulating us more tightly (say cheese ACN). Sometimes, its hard to explain how the corporate world could be even more irritating than the federal government. The blame shifts again back on us however, as we have gently rolled over for these jerks and it continues to pay off...for them.

  • The federal government in wielding restrictive legislation with the precision of a sledgehammer. The result is an inexplicably complex federal health care system that is confusing to it's beneficiaries and frustrating for it's providers. Are we sure we want to turn the whole thing over to these hacks? If your answer is 'yes', you clearly have never picked up a copy of our federal tax code.

  • Our patients in creating a culture of unaccountability from of our actions. The founders of our country would probably get nauseated at the sight of our behaviors.
    Despite incontrovertible medical evidence, public awareness, corporate and federal funding, our nation continues to resist adopting healthy behaviors. Trips to the local gym aren't nearly as frequent as those to the troughs of the local all-you-can-eat buffet. Pictures like the well-nourished gentleman above would be hilarious if they weren't so sad.

The Ugly

One might say we aren't handling these challenges very well. We whine at legislative defeats, but refuse to contribute to our PAC. We bemoan the pitiful reimbursement from third-party payors, but continue to feed off these scraps. We get upset at fringe providers who continue to practice voodoo like craniosacral and myofascial therapy, but don't have the guts to force our own professional organization to marginalize them. Lastly, we complain our patients are fat and smoke too much, yet don't take enough time to counsel them in an appropriate manner. Basically, we aren't contributing much to a solution.

Working Toward a Solution

We are free to blame the federal government, third party payors, and even patients for our problems. In the end, it's wasted energy without salient action. Those actually doing the heavy lifting for our profession are too busy to complain. They are busy actively researching, teaching, and advocating for a profession that largely doesn't act like it wants to play in the big leagues. The next time you complain about reimbursement, POPTS, payors, or patients, you may want to take an inventory to decide just which side of this funny little equation you are on.

Sorry, but treating patients isn't enough. We get paid to do that remember? Conscious effort beyond the call of duty is required to shift this equilibrium toward a favorable outcome. Contribute to our profession beyond the time-clock. Teach. Perform clinical research. Write your congressman. Give time to your local school district, community, or church. Doing something will always trump complaining about everything.

Lastly. I would be remiss if I didn't state the obvious: It is an election year with serious implications for the future of our health care system. Please vote! Remember. Our vision for 2020 is worthless without action in 2008.


  1. What do you think about a national flat rate?

    As a PT practice owner I'd love some certainty as to my cash flow.

    I'd also love to reduce my costs on my back office.

    As it is now, to retain in-house billing I have to hire 'experts' or be willing to train someone for 3-6 months to bill and reconcile accounts.

    Finally, to what extent will 'Vision 2020' allow physical therapists to divorce themselves from the unholy alliance between providers, payers and patients?

    Tim Richardson, PT (blog)

  2. Tim. I might consider that but I can imagine how much rangling there would be over what the flat rate should be, when it should escalate, and who (most importantly) would have oversight over the rate changes.

    I'm not much of a federalist, but understand the need for some local governmental regulation. What works in Omaha won't be sufficient in Scottsdale for example.

    It'd be nice for the payors to jump on this, but I think we'd just see another ACN fiasco-ripoff.

    I need to read 2020 another time. I'd like to see it's vision for extracting ourselves from third party reimbursement. I doubt we'd see much, but I'll have a look.

  3. Good post, Roderick.

    I think it's important to look at the APTA as another example of "the bad". While we're hammering away at doctorates, we still do not have direct access in many states (including Texas). This has to become a very real priority. Until that happens, doctorates are really a moot point and are putting the cart before the proverbial horse.

    Allan Besselink, PT, Dip.MDT

  4. Hey Rod (hope I can call you that)
    thanks for the kind words on my blog. I truly do enjoy your blog and have been inspired by a number of your posts. I always love learning from the PT's who have been out there and getting things done, there is nothing better for me as a "New Professional".

    This whole VISION 2020 thing seems to be very controversial. It seems until we as a profession become a united voice as to the direction we want to head towards a lot less will be accomplished. We can plug a lot of holes in many of the aspects of the vision but solutions are the thing most difficult to come by but I must say you offer some fantastic and reasonable pieces to those solutions.

    All the best