Changes because of the caps

[Guest guest]

Drew,

To be quite honest, a 10 year career is not that long to base your

conclusions on. Secondly, if I had SOME (meaning more than one or two)

experiences of being employed by less than ethical employers, I might begin

to question the wisdom of my selection process in choosing suitable

employers. I do have to say that after 26 1/2 years experience involving

practicing in 4 different states and teaching at least a couple of hundred

CE courses in about 40 states, I'd have to STRONGLY disagree on where the

lesser quality of care is likely to occur ... but that's just based on my

experience.

Re: Changes because of the caps

> ,

>

> If YOU were offended, then I must have simply miscommunicated badly.

> You've not been one to miss my meaning. Let me try again . . .

>

> I KNOW that not all private-practices operate in a " conveyor belt "

> manner. I also am quite aware that we disagree as to where the

> lesser quality of care is likely to occur. I KNOW that over the

> course of my 10 year career, that I've worked short stents for some

> less than ethical employers/bosses, and that because they tended to

> be either corporates or non-PT owners of private practices, that I'm

> a bit jaded.

>

> Either way you're missing my point.

>

> Inproprieties, or at least the appearence thereof, DO exist, and the

> public perception is that they are far more common in private

> practices than hospital outpatient clinics. This is because of the

> assumption that the hosptial outpatient clinics has greater resources

> and don't need to do anything questionable to attact patients. Fact

> or not, truth or not, that is, I believe, public perception.

>

> It is perceptions and extreme statements that is, or at least should

> be, at the heart of the discussion. I am not pro-cap, nor do I think

> that hospital therapy centers always provide better can than

> outpatient clinics --- so why are we discussing this situation in

> terms of the cap having COMPLETELY negative impact. The fact of the

> matter is that the cap won't impact nearly as many patients as we'd

> as PT's against the cap might have the public believe, and GENERALLY

> SPEAKING (I know there are a few exceptions) the ones that it does

> impact are more likely to need more comprehensive care and broader

> resources that (in my experience anyway) the hospital is more likely

> to have.

>

> My point, again, and maybe I've simply communicated it wrong, is

> almost exactly what yours seems to be --- that we should not only

> focus upon how it's inappropriate and professionally offensive to

> impose a cap on one clinical doctoring profession and not all (can

> you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

> Chiropractic Cap?) --- but also suggest that we focus our discussion

> upon those situations where a patient might be affected. To do so

> presents a far more professional argument than " the Cap is completely

> bad and has no positive elements, " which is, in my opinion, a

> dangerous game that we're playing. Otherwise, I fear we're going to

> end up sounding a little less professional and a little less educated

> than I believe our profession to be.

>

> Dr. M. Ball, PT, DPT, PhD

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>

[Guest guest]

Drew,

To be quite honest, a 10 year career is not that long to base your

conclusions on. Secondly, if I had SOME (meaning more than one or two)

experiences of being employed by less than ethical employers, I might begin

to question the wisdom of my selection process in choosing suitable

employers. I do have to say that after 26 1/2 years experience involving

practicing in 4 different states and teaching at least a couple of hundred

CE courses in about 40 states, I'd have to STRONGLY disagree on where the

lesser quality of care is likely to occur ... but that's just based on my

experience.

Re: Changes because of the caps

> ,

>

> If YOU were offended, then I must have simply miscommunicated badly.

> You've not been one to miss my meaning. Let me try again . . .

>

> I KNOW that not all private-practices operate in a " conveyor belt "

> manner. I also am quite aware that we disagree as to where the

> lesser quality of care is likely to occur. I KNOW that over the

> course of my 10 year career, that I've worked short stents for some

> less than ethical employers/bosses, and that because they tended to

> be either corporates or non-PT owners of private practices, that I'm

> a bit jaded.

>

> Either way you're missing my point.

>

> Inproprieties, or at least the appearence thereof, DO exist, and the

> public perception is that they are far more common in private

> practices than hospital outpatient clinics. This is because of the

> assumption that the hosptial outpatient clinics has greater resources

> and don't need to do anything questionable to attact patients. Fact

> or not, truth or not, that is, I believe, public perception.

>

> It is perceptions and extreme statements that is, or at least should

> be, at the heart of the discussion. I am not pro-cap, nor do I think

> that hospital therapy centers always provide better can than

> outpatient clinics --- so why are we discussing this situation in

> terms of the cap having COMPLETELY negative impact. The fact of the

> matter is that the cap won't impact nearly as many patients as we'd

> as PT's against the cap might have the public believe, and GENERALLY

> SPEAKING (I know there are a few exceptions) the ones that it does

> impact are more likely to need more comprehensive care and broader

> resources that (in my experience anyway) the hospital is more likely

> to have.

>

> My point, again, and maybe I've simply communicated it wrong, is

> almost exactly what yours seems to be --- that we should not only

> focus upon how it's inappropriate and professionally offensive to

> impose a cap on one clinical doctoring profession and not all (can

> you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

> Chiropractic Cap?) --- but also suggest that we focus our discussion

> upon those situations where a patient might be affected. To do so

> presents a far more professional argument than " the Cap is completely

> bad and has no positive elements, " which is, in my opinion, a

> dangerous game that we're playing. Otherwise, I fear we're going to

> end up sounding a little less professional and a little less educated

> than I believe our profession to be.

>

> Dr. M. Ball, PT, DPT, PhD

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>

[Guest guest]

Drew,

To be quite honest, a 10 year career is not that long to base your

conclusions on. Secondly, if I had SOME (meaning more than one or two)

experiences of being employed by less than ethical employers, I might begin

to question the wisdom of my selection process in choosing suitable

employers. I do have to say that after 26 1/2 years experience involving

practicing in 4 different states and teaching at least a couple of hundred

CE courses in about 40 states, I'd have to STRONGLY disagree on where the

lesser quality of care is likely to occur ... but that's just based on my

experience.

Re: Changes because of the caps

> ,

>

> If YOU were offended, then I must have simply miscommunicated badly.

> You've not been one to miss my meaning. Let me try again . . .

>

> I KNOW that not all private-practices operate in a " conveyor belt "

> manner. I also am quite aware that we disagree as to where the

> lesser quality of care is likely to occur. I KNOW that over the

> course of my 10 year career, that I've worked short stents for some

> less than ethical employers/bosses, and that because they tended to

> be either corporates or non-PT owners of private practices, that I'm

> a bit jaded.

>

> Either way you're missing my point.

>

> Inproprieties, or at least the appearence thereof, DO exist, and the

> public perception is that they are far more common in private

> practices than hospital outpatient clinics. This is because of the

> assumption that the hosptial outpatient clinics has greater resources

> and don't need to do anything questionable to attact patients. Fact

> or not, truth or not, that is, I believe, public perception.

>

> It is perceptions and extreme statements that is, or at least should

> be, at the heart of the discussion. I am not pro-cap, nor do I think

> that hospital therapy centers always provide better can than

> outpatient clinics --- so why are we discussing this situation in

> terms of the cap having COMPLETELY negative impact. The fact of the

> matter is that the cap won't impact nearly as many patients as we'd

> as PT's against the cap might have the public believe, and GENERALLY

> SPEAKING (I know there are a few exceptions) the ones that it does

> impact are more likely to need more comprehensive care and broader

> resources that (in my experience anyway) the hospital is more likely

> to have.

>

> My point, again, and maybe I've simply communicated it wrong, is

> almost exactly what yours seems to be --- that we should not only

> focus upon how it's inappropriate and professionally offensive to

> impose a cap on one clinical doctoring profession and not all (can

> you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

> Chiropractic Cap?) --- but also suggest that we focus our discussion

> upon those situations where a patient might be affected. To do so

> presents a far more professional argument than " the Cap is completely

> bad and has no positive elements, " which is, in my opinion, a

> dangerous game that we're playing. Otherwise, I fear we're going to

> end up sounding a little less professional and a little less educated

> than I believe our profession to be.

>

> Dr. M. Ball, PT, DPT, PhD

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>

[Guest guest]

I am surprised and dismayed to see my comments being twisted and

morphed into a discussion regarding ethics in hosptial-based versus

outpatient clinics. That was not my intent, nor is it my position.

Furthermore, I think we can do without personal attacks here. At

some point experience is experience (how much difference is there

between the PT with 11 versus 12 years, or 15 versus 20 --- it

depends). Positive experiences, and mistakes, make for the

professionals we are today. Experiences (both positive and negative)

is but one quality, along with (in no particular order) educational

degrees, continuing education, personality, evidence-mediated

decision making, intuition, profesionalism, etc., etc., etc., that

blend to form the best of the PT's that this profession has to

offer. Other than to give others simple baseline information as to

where we're coming from, any one factor has little to no value in

this forum, and to try to use, or interpret it as some kind of

attempt to gain professional higher ground is just silly.

Let's try this again, and for one final time . . .

My point was, and is that with less than 40 days until the cap goes

into effect, that it is high time to discuss SPECIFICALLY what

patients the cap is going to impact negatively. It WILL negatively

impact patients being billed part B for long-term care, it WILL

negatively impact patients who upon exhausting benefits will have to

drive to a distant hosptial --- assuming one exists within a

reasonable distance in the first place. I continune to disagree with

, however, that the cap will be 100% bad. There are a SOME

patients that, due to hospital resources that the outpatient clinic

often doesn't have, may be better suited for the most medically

complex of patients. This, of course, is not an abolute, and there

are, of course, exceptions. It is, in the end, an opinion. What

none of you are focusing upon, however, is the other side of the

coin, which is that there are patients that are much better served in

the private PT clinic than the hosptial outpatient clinic who MAY end

up getting shafted.

Let's talk about those specific patients, and avoid the en masse. I

respecfully disagree with what I think is 's position (and make

no mistake, I have GREAT professional and personal respect for )

that it is at this point in time still an effective strategy to try

to fight the cap en-masse because we THINK (but don't really know)

that it will have negative impact for all, or even the majority of

patients. I don't disagree with the argument, I'd just like to see

it more productive.

Let's talk about the need for waivers for the patient who happens to

have plantar fascitis and a small RTC repair in the same year ---

they certainly aren't patients that would be better served in one

type of clinic over another. Let's talk about an appeals process for

the patients in long-term care facilities that are going to be out of

benefits after a very short period of time. What is our position on

these patients? Are we going to fight for appeals? Is this an

opportunity for PT's to begin to change their renumeration structure

by billing the patient directly? By billing the facility for

contract services? Could the cap, in some situations, have the

unintended POSTIVE impact of promoting the autonomy of the physical

therapist in those states that allow direct access, but not direct

reimbursement? Could the cap, in some situations, get PT's thinking

about more dynamic and more innovative means of reimbursement/payment

that actually breaks the mold and progresses the autonomy of the

profession? If not, if no alternative model works (e.g. patients and

facilities don't want to pay the clinician directly) what does that

say about the public value of our profession? What does that say

about how we market ourselves?

In addition, the cap is likely to have a negative impact upon POPTS,

and may make the prospect of a POPTS less economically attractive to

an MD who'd in the end rather now not be bothered. Pro-POPTS, anti-

POPTS, or in-between, personally I'll not disclose, but the APTA is

certainly against them. The cap just may slow their proliferation.

Don't get me wrong, I'm still not pro-cap, but the fact is that the

cap may have some unintended positive effects. In that vein, I

suggest that with less than 40 days until it goes into effect, that

we re-focus our discussion upon which patients, SPECIFICALLY, it WILL

negatively impact --- not the ones we, with broad brush THINK it will

impact.

M. Ball, PT, DPT, PhD

[Guest guest]

I don't recall making any statement about the ethics involved but I did

comment on quality of care. Iin thinking of the various PTs across the

country who I feel would render the best quality of care in an outpatient

orthopaedic sitting, almost all of the names that come to mind are private

practitioners. That's not to say that excellent therapists do not exist in

hospitals or other institutions but they certainly are not as common as top

of the line private practitioners. How many innovators of new treatment

methodologies have come out of institutions versus private practices?

Capitalism works for a reason. When there is financial incentive to better

oneself, you generally see a better quality of practitioner. On a personal

level, if I look at my continuing education allowance over my career

(courses, books, journals, audio media, visual media, etc.), it has

conservatively averaged $5K or more dollars a year. I don't know too many

institutions who are that generous with their employees, do you? I think

the more we invest time and money in helping our patients, the more

effective we can be as practitioners. If I sound like a cheerleader for

private practice, I am.

Re: Changes because of the caps

>

>

>> ,

>>

>> If YOU were offended, then I must have simply miscommunicated badly.

>> You've not been one to miss my meaning. Let me try again . . .

>>

>> I KNOW that not all private-practices operate in a " conveyor belt "

>> manner. I also am quite aware that we disagree as to where the

>> lesser quality of care is likely to occur. I KNOW that over the

>> course of my 10 year career, that I've worked short stents for some

>> less than ethical employers/bosses, and that because they tended to

>> be either corporates or non-PT owners of private practices, that I'm

>> a bit jaded.

>>

>> Either way you're missing my point.

>>

>> Inproprieties, or at least the appearence thereof, DO exist, and the

>> public perception is that they are far more common in private

>> practices than hospital outpatient clinics. This is because of the

>> assumption that the hosptial outpatient clinics has greater resources

>> and don't need to do anything questionable to attact patients. Fact

>> or not, truth or not, that is, I believe, public perception.

>>

>> It is perceptions and extreme statements that is, or at least should

>> be, at the heart of the discussion. I am not pro-cap, nor do I think

>> that hospital therapy centers always provide better can than

>> outpatient clinics --- so why are we discussing this situation in

>> terms of the cap having COMPLETELY negative impact. The fact of the

>> matter is that the cap won't impact nearly as many patients as we'd

>> as PT's against the cap might have the public believe, and GENERALLY

>> SPEAKING (I know there are a few exceptions) the ones that it does

>> impact are more likely to need more comprehensive care and broader

>> resources that (in my experience anyway) the hospital is more likely

>> to have.

>>

>> My point, again, and maybe I've simply communicated it wrong, is

>> almost exactly what yours seems to be --- that we should not only

>> focus upon how it's inappropriate and professionally offensive to

>> impose a cap on one clinical doctoring profession and not all (can

>> you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

>> Chiropractic Cap?) --- but also suggest that we focus our discussion

>> upon those situations where a patient might be affected. To do so

>> presents a far more professional argument than " the Cap is completely

>> bad and has no positive elements, " which is, in my opinion, a

>> dangerous game that we're playing. Otherwise, I fear we're going to

>> end up sounding a little less professional and a little less educated

>> than I believe our profession to be.

>>

>> Dr. M. Ball, PT, DPT, PhD

>>

>>

>>

>>

>>

>>

>>

>> Looking to start and own 100% of your own Practice?

>> Visit www.InHomeRehab.com.

>> PTManager encourages participation in your professional association.

>> Join

>

>> and participate now!

>>

[Guest guest]

I don't recall making any statement about the ethics involved but I did

comment on quality of care. Iin thinking of the various PTs across the

country who I feel would render the best quality of care in an outpatient

orthopaedic sitting, almost all of the names that come to mind are private

practitioners. That's not to say that excellent therapists do not exist in

hospitals or other institutions but they certainly are not as common as top

of the line private practitioners. How many innovators of new treatment

methodologies have come out of institutions versus private practices?

Capitalism works for a reason. When there is financial incentive to better

oneself, you generally see a better quality of practitioner. On a personal

level, if I look at my continuing education allowance over my career

(courses, books, journals, audio media, visual media, etc.), it has

conservatively averaged $5K or more dollars a year. I don't know too many

institutions who are that generous with their employees, do you? I think

the more we invest time and money in helping our patients, the more

effective we can be as practitioners. If I sound like a cheerleader for

private practice, I am.

Re: Changes because of the caps

>

>

>> ,

>>

>> If YOU were offended, then I must have simply miscommunicated badly.

>> You've not been one to miss my meaning. Let me try again . . .

>>

>> I KNOW that not all private-practices operate in a " conveyor belt "

>> manner. I also am quite aware that we disagree as to where the

>> lesser quality of care is likely to occur. I KNOW that over the

>> course of my 10 year career, that I've worked short stents for some

>> less than ethical employers/bosses, and that because they tended to

>> be either corporates or non-PT owners of private practices, that I'm

>> a bit jaded.

>>

>> Either way you're missing my point.

>>

>> Inproprieties, or at least the appearence thereof, DO exist, and the

>> public perception is that they are far more common in private

>> practices than hospital outpatient clinics. This is because of the

>> assumption that the hosptial outpatient clinics has greater resources

>> and don't need to do anything questionable to attact patients. Fact

>> or not, truth or not, that is, I believe, public perception.

>>

>> It is perceptions and extreme statements that is, or at least should

>> be, at the heart of the discussion. I am not pro-cap, nor do I think

>> that hospital therapy centers always provide better can than

>> outpatient clinics --- so why are we discussing this situation in

>> terms of the cap having COMPLETELY negative impact. The fact of the

>> matter is that the cap won't impact nearly as many patients as we'd

>> as PT's against the cap might have the public believe, and GENERALLY

>> SPEAKING (I know there are a few exceptions) the ones that it does

>> impact are more likely to need more comprehensive care and broader

>> resources that (in my experience anyway) the hospital is more likely

>> to have.

>>

>> My point, again, and maybe I've simply communicated it wrong, is

>> almost exactly what yours seems to be --- that we should not only

>> focus upon how it's inappropriate and professionally offensive to

>> impose a cap on one clinical doctoring profession and not all (can

>> you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

>> Chiropractic Cap?) --- but also suggest that we focus our discussion

>> upon those situations where a patient might be affected. To do so

>> presents a far more professional argument than " the Cap is completely

>> bad and has no positive elements, " which is, in my opinion, a

>> dangerous game that we're playing. Otherwise, I fear we're going to

>> end up sounding a little less professional and a little less educated

>> than I believe our profession to be.

>>

>> Dr. M. Ball, PT, DPT, PhD

>>

>>

>>

>>

>>

>>

>>

>> Looking to start and own 100% of your own Practice?

>> Visit www.InHomeRehab.com.

>> PTManager encourages participation in your professional association.

>> Join

>

>> and participate now!

>>

[Guest guest]

I don't recall making any statement about the ethics involved but I did

comment on quality of care. Iin thinking of the various PTs across the

country who I feel would render the best quality of care in an outpatient

orthopaedic sitting, almost all of the names that come to mind are private

practitioners. That's not to say that excellent therapists do not exist in

hospitals or other institutions but they certainly are not as common as top

of the line private practitioners. How many innovators of new treatment

methodologies have come out of institutions versus private practices?

Capitalism works for a reason. When there is financial incentive to better

oneself, you generally see a better quality of practitioner. On a personal

level, if I look at my continuing education allowance over my career

(courses, books, journals, audio media, visual media, etc.), it has

conservatively averaged $5K or more dollars a year. I don't know too many

institutions who are that generous with their employees, do you? I think

the more we invest time and money in helping our patients, the more

effective we can be as practitioners. If I sound like a cheerleader for

private practice, I am.

Re: Changes because of the caps

>

>

>> ,

>>

>> If YOU were offended, then I must have simply miscommunicated badly.

>> You've not been one to miss my meaning. Let me try again . . .

>>

>> I KNOW that not all private-practices operate in a " conveyor belt "

>> manner. I also am quite aware that we disagree as to where the

>> lesser quality of care is likely to occur. I KNOW that over the

>> course of my 10 year career, that I've worked short stents for some

>> less than ethical employers/bosses, and that because they tended to

>> be either corporates or non-PT owners of private practices, that I'm

>> a bit jaded.

>>

>> Either way you're missing my point.

>>

>> Inproprieties, or at least the appearence thereof, DO exist, and the

>> public perception is that they are far more common in private

>> practices than hospital outpatient clinics. This is because of the

>> assumption that the hosptial outpatient clinics has greater resources

>> and don't need to do anything questionable to attact patients. Fact

>> or not, truth or not, that is, I believe, public perception.

>>

>> It is perceptions and extreme statements that is, or at least should

>> be, at the heart of the discussion. I am not pro-cap, nor do I think

>> that hospital therapy centers always provide better can than

>> outpatient clinics --- so why are we discussing this situation in

>> terms of the cap having COMPLETELY negative impact. The fact of the

>> matter is that the cap won't impact nearly as many patients as we'd

>> as PT's against the cap might have the public believe, and GENERALLY

>> SPEAKING (I know there are a few exceptions) the ones that it does

>> impact are more likely to need more comprehensive care and broader

>> resources that (in my experience anyway) the hospital is more likely

>> to have.

>>

>> My point, again, and maybe I've simply communicated it wrong, is

>> almost exactly what yours seems to be --- that we should not only

>> focus upon how it's inappropriate and professionally offensive to

>> impose a cap on one clinical doctoring profession and not all (can

>> you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

>> Chiropractic Cap?) --- but also suggest that we focus our discussion

>> upon those situations where a patient might be affected. To do so

>> presents a far more professional argument than " the Cap is completely

>> bad and has no positive elements, " which is, in my opinion, a

>> dangerous game that we're playing. Otherwise, I fear we're going to

>> end up sounding a little less professional and a little less educated

>> than I believe our profession to be.

>>

>> Dr. M. Ball, PT, DPT, PhD

>>

>>

>>

>>

>>

>>

>>

>> Looking to start and own 100% of your own Practice?

>> Visit www.InHomeRehab.com.

>> PTManager encourages participation in your professional association.

>> Join

>

>> and participate now!

>>

[Guest guest]

Sorry if you interpreted anything I said as a personal attack. That was not

my intent. It was simply a statement that your perspective on the situation

is of shorter duration than the perspective of some others on the situation

.... no attack ... just a statement of fact. Many PTs are not aware of the

history of their profession and as in almost any other walk of life, failure

to know history leads to repeating past mistakes, reinventing the wheel,

etc. Anyway, all things being equal, I'd always go with more experience.

Would you select a surgeon with 5 years experience or 25 years for a

critical operation? All things being equal, I know who I'd pick.

Unfortunately, there is a tendency in modern Western culture to ignore the

wisdom which comes from age and experience. Placing value on experience is

not being silly, it's not an attempt to take any type of imagined higher

ground, it's simply an intelligent decision.

Re: Changes because of the caps

>I am surprised and dismayed to see my comments being twisted and

> morphed into a discussion regarding ethics in hosptial-based versus

> outpatient clinics. That was not my intent, nor is it my position.

> Furthermore, I think we can do without personal attacks here. At

> some point experience is experience (how much difference is there

> between the PT with 11 versus 12 years, or 15 versus 20 --- it

> depends). Positive experiences, and mistakes, make for the

> professionals we are today. Experiences (both positive and negative)

> is but one quality, along with (in no particular order) educational

> degrees, continuing education, personality, evidence-mediated

> decision making, intuition, profesionalism, etc., etc., etc., that

> blend to form the best of the PT's that this profession has to

> offer. Other than to give others simple baseline information as to

> where we're coming from, any one factor has little to no value in

> this forum, and to try to use, or interpret it as some kind of

> attempt to gain professional higher ground is just silly.

>

> Let's try this again, and for one final time . . .

>

> My point was, and is that with less than 40 days until the cap goes

> into effect, that it is high time to discuss SPECIFICALLY what

> patients the cap is going to impact negatively. It WILL negatively

> impact patients being billed part B for long-term care, it WILL

> negatively impact patients who upon exhausting benefits will have to

> drive to a distant hosptial --- assuming one exists within a

> reasonable distance in the first place. I continune to disagree with

> , however, that the cap will be 100% bad. There are a SOME

> patients that, due to hospital resources that the outpatient clinic

> often doesn't have, may be better suited for the most medically

> complex of patients. This, of course, is not an abolute, and there

> are, of course, exceptions. It is, in the end, an opinion. What

> none of you are focusing upon, however, is the other side of the

> coin, which is that there are patients that are much better served in

> the private PT clinic than the hosptial outpatient clinic who MAY end

> up getting shafted.

>

> Let's talk about those specific patients, and avoid the en masse. I

> respecfully disagree with what I think is 's position (and make

> no mistake, I have GREAT professional and personal respect for )

> that it is at this point in time still an effective strategy to try

> to fight the cap en-masse because we THINK (but don't really know)

> that it will have negative impact for all, or even the majority of

> patients. I don't disagree with the argument, I'd just like to see

> it more productive.

>

> Let's talk about the need for waivers for the patient who happens to

> have plantar fascitis and a small RTC repair in the same year ---

> they certainly aren't patients that would be better served in one

> type of clinic over another. Let's talk about an appeals process for

> the patients in long-term care facilities that are going to be out of

> benefits after a very short period of time. What is our position on

> these patients? Are we going to fight for appeals? Is this an

> opportunity for PT's to begin to change their renumeration structure

> by billing the patient directly? By billing the facility for

> contract services? Could the cap, in some situations, have the

> unintended POSTIVE impact of promoting the autonomy of the physical

> therapist in those states that allow direct access, but not direct

> reimbursement? Could the cap, in some situations, get PT's thinking

> about more dynamic and more innovative means of reimbursement/payment

> that actually breaks the mold and progresses the autonomy of the

> profession? If not, if no alternative model works (e.g. patients and

> facilities don't want to pay the clinician directly) what does that

> say about the public value of our profession? What does that say

> about how we market ourselves?

>

> In addition, the cap is likely to have a negative impact upon POPTS,

> and may make the prospect of a POPTS less economically attractive to

> an MD who'd in the end rather now not be bothered. Pro-POPTS, anti-

> POPTS, or in-between, personally I'll not disclose, but the APTA is

> certainly against them. The cap just may slow their proliferation.

>

> Don't get me wrong, I'm still not pro-cap, but the fact is that the

> cap may have some unintended positive effects. In that vein, I

> suggest that with less than 40 days until it goes into effect, that

> we re-focus our discussion upon which patients, SPECIFICALLY, it WILL

> negatively impact --- not the ones we, with broad brush THINK it will

> impact.

>

> M. Ball, PT, DPT, PhD

>

>

>

>

>

>

>

>

> Looking to start and own 100% of your own Practice?

> Visit www.InHomeRehab.com.

> PTManager encourages participation in your professional association. Join

> and participate now!

>

> Please identify yourself in all postings to PTManager.

>

[Guest guest]

Drew wrote-

In addition, the cap is likely to have a negative impact upon POPTS,

and may make the prospect of a POPTS less economically attractive to

an MD who'd in the end rather now not be bothered. Pro-POPTS, anti-

POPTS, or in-between, personally I'll not disclose, but the APTA is

certainly against them. The cap just may slow their proliferation.

I agree if the cap goes into place that providers will rise to find new

strategies to help the public and remain viable, however the

paragraph above gave me images of a CMS chemotherapy

program- one that takes out the " problem cells " , but robs and

almost kills the other cells and organs.

Dee Daley, PT

Southern Pines, NC

[Guest guest]

Drew wrote-

In addition, the cap is likely to have a negative impact upon POPTS,

and may make the prospect of a POPTS less economically attractive to

an MD who'd in the end rather now not be bothered. Pro-POPTS, anti-

POPTS, or in-between, personally I'll not disclose, but the APTA is

certainly against them. The cap just may slow their proliferation.

I agree if the cap goes into place that providers will rise to find new

strategies to help the public and remain viable, however the

paragraph above gave me images of a CMS chemotherapy

program- one that takes out the " problem cells " , but robs and

almost kills the other cells and organs.

Dee Daley, PT

Southern Pines, NC

[Guest guest]

Regarding: " If I sound like a cheerleader for private practice, I am. "

Please, be a cheerleader for quality, and for patient choice, but beware the

trap of embellishing the qualities of individuals based on the corporate

charter under which they work.

$5,000.00 per year is indeed a lot of CE dollars---even more so if you

consider the time away from work needed to spend it---but is that typical in

private practice settings? And more important, is that the end-all and

be-all of professional development? Our hospital therapists, in addition to

CE, take advantage of opportunities to share orthopedic rounds and visit

surgeries, have frequent face-to-face consultations with referring

physicians, engage in formal and informal peer-to-peer (PT, OT, ST,

physician, and others) education, and other such activities that would be

hard to duplicate in a private practice setting. Should I therefore tout

hospital-based practice as the de facto superior service? Of course not.

Just as the best practitioners will always seek quality wherever they exist,

likewise so will the best managers. Quality emerges from within the

individual, not from a corporate charter.

Regarding: " Capitalism works for a reason. "

Those of you who believe you are practicing in a capitalist system should

climb out from under your pile of charts and take a good look at the

third-party-payer monolith. As the list serve amply demonstrates, kadoidling

with third-parties and regulators has these days become much more than a

mere adjunct to practice. Third-parties are now the primary movers and

shakers, and our reactions to them define our forms of practice. They rule

us, and they rule our patients. (Once again, please support Healthcare

Savings Accounts!)

And last but not least, while I disagree with Mark Dwyer's implication that

a low profile (i.e. the profile of a therapist who has not demonstrated his

qualities by teaching or writing or the like) equates with less quality, I

wholeheartedly cheer his obvious personal commitment to quality, and exhort

others to follow his lead.

Dave Milano, PT, Director of Rehab Services

Laurel Health System

32-36 Central Ave.

Wellsboro, PA 16901

dmilano@...

Re: Re: Changes because of the caps

I don't recall making any statement about the ethics involved but I did

comment on quality of care. Iin thinking of the various PTs across the

country who I feel would render the best quality of care in an outpatient

orthopaedic sitting, almost all of the names that come to mind are private

practitioners. That's not to say that excellent therapists do not exist in

hospitals or other institutions but they certainly are not as common as top

of the line private practitioners. How many innovators of new treatment

methodologies have come out of institutions versus private practices?

Capitalism works for a reason. When there is financial incentive to better

oneself, you generally see a better quality of practitioner. On a personal

level, if I look at my continuing education allowance over my career

(courses, books, journals, audio media, visual media, etc.), it has

conservatively averaged $5K or more dollars a year. I don't know too many

institutions who are that generous with their employees, do you? I think

the more we invest time and money in helping our patients, the more

effective we can be as practitioners. If I sound like a cheerleader for

private practice, I am.

Re: Changes because of the caps

>

>

>> ,

>>

>> If YOU were offended, then I must have simply miscommunicated badly.

>> You've not been one to miss my meaning. Let me try again . . .

>>

>> I KNOW that not all private-practices operate in a " conveyor belt "

>> manner. I also am quite aware that we disagree as to where the

>> lesser quality of care is likely to occur. I KNOW that over the

>> course of my 10 year career, that I've worked short stents for some

>> less than ethical employers/bosses, and that because they tended to

>> be either corporates or non-PT owners of private practices, that I'm

>> a bit jaded.

>>

>> Either way you're missing my point.

>>

>> Inproprieties, or at least the appearence thereof, DO exist, and the

>> public perception is that they are far more common in private

>> practices than hospital outpatient clinics. This is because of the

>> assumption that the hosptial outpatient clinics has greater resources

>> and don't need to do anything questionable to attact patients. Fact

>> or not, truth or not, that is, I believe, public perception.

>>

>> It is perceptions and extreme statements that is, or at least should

>> be, at the heart of the discussion. I am not pro-cap, nor do I think

>> that hospital therapy centers always provide better can than

>> outpatient clinics --- so why are we discussing this situation in

>> terms of the cap having COMPLETELY negative impact. The fact of the

>> matter is that the cap won't impact nearly as many patients as we'd

>> as PT's against the cap might have the public believe, and GENERALLY

>> SPEAKING (I know there are a few exceptions) the ones that it does

>> impact are more likely to need more comprehensive care and broader

>> resources that (in my experience anyway) the hospital is more likely

>> to have.

>>

>> My point, again, and maybe I've simply communicated it wrong, is

>> almost exactly what yours seems to be --- that we should not only

>> focus upon how it's inappropriate and professionally offensive to

>> impose a cap on one clinical doctoring profession and not all (can

>> you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

>> Chiropractic Cap?) --- but also suggest that we focus our discussion

>> upon those situations where a patient might be affected. To do so

>> presents a far more professional argument than " the Cap is completely

>> bad and has no positive elements, " which is, in my opinion, a

>> dangerous game that we're playing. Otherwise, I fear we're going to

>> end up sounding a little less professional and a little less educated

>> than I believe our profession to be.

>>

>> Dr. M. Ball, PT, DPT, PhD

>>

>>

>>

>>

>>

>>

>>

>> Looking to start and own 100% of your own Practice?

>> Visit www.InHomeRehab.com.

>> PTManager encourages participation in your professional association.

>> Join

>

>> and participate now!

>>

[Guest guest]

Regarding: " If I sound like a cheerleader for private practice, I am. "

Please, be a cheerleader for quality, and for patient choice, but beware the

trap of embellishing the qualities of individuals based on the corporate

charter under which they work.

$5,000.00 per year is indeed a lot of CE dollars---even more so if you

consider the time away from work needed to spend it---but is that typical in

private practice settings? And more important, is that the end-all and

be-all of professional development? Our hospital therapists, in addition to

CE, take advantage of opportunities to share orthopedic rounds and visit

surgeries, have frequent face-to-face consultations with referring

physicians, engage in formal and informal peer-to-peer (PT, OT, ST,

physician, and others) education, and other such activities that would be

hard to duplicate in a private practice setting. Should I therefore tout

hospital-based practice as the de facto superior service? Of course not.

Just as the best practitioners will always seek quality wherever they exist,

likewise so will the best managers. Quality emerges from within the

individual, not from a corporate charter.

Regarding: " Capitalism works for a reason. "

Those of you who believe you are practicing in a capitalist system should

climb out from under your pile of charts and take a good look at the

third-party-payer monolith. As the list serve amply demonstrates, kadoidling

with third-parties and regulators has these days become much more than a

mere adjunct to practice. Third-parties are now the primary movers and

shakers, and our reactions to them define our forms of practice. They rule

us, and they rule our patients. (Once again, please support Healthcare

Savings Accounts!)

And last but not least, while I disagree with Mark Dwyer's implication that

a low profile (i.e. the profile of a therapist who has not demonstrated his

qualities by teaching or writing or the like) equates with less quality, I

wholeheartedly cheer his obvious personal commitment to quality, and exhort

others to follow his lead.

Dave Milano, PT, Director of Rehab Services

Laurel Health System

32-36 Central Ave.

Wellsboro, PA 16901

dmilano@...

Re: Re: Changes because of the caps

I don't recall making any statement about the ethics involved but I did

comment on quality of care. Iin thinking of the various PTs across the

country who I feel would render the best quality of care in an outpatient

orthopaedic sitting, almost all of the names that come to mind are private

practitioners. That's not to say that excellent therapists do not exist in

hospitals or other institutions but they certainly are not as common as top

of the line private practitioners. How many innovators of new treatment

methodologies have come out of institutions versus private practices?

Capitalism works for a reason. When there is financial incentive to better

oneself, you generally see a better quality of practitioner. On a personal

level, if I look at my continuing education allowance over my career

(courses, books, journals, audio media, visual media, etc.), it has

conservatively averaged $5K or more dollars a year. I don't know too many

institutions who are that generous with their employees, do you? I think

the more we invest time and money in helping our patients, the more

effective we can be as practitioners. If I sound like a cheerleader for

private practice, I am.

Re: Changes because of the caps

>

>

>> ,

>>

>> If YOU were offended, then I must have simply miscommunicated badly.

>> You've not been one to miss my meaning. Let me try again . . .

>>

>> I KNOW that not all private-practices operate in a " conveyor belt "

>> manner. I also am quite aware that we disagree as to where the

>> lesser quality of care is likely to occur. I KNOW that over the

>> course of my 10 year career, that I've worked short stents for some

>> less than ethical employers/bosses, and that because they tended to

>> be either corporates or non-PT owners of private practices, that I'm

>> a bit jaded.

>>

>> Either way you're missing my point.

>>

>> Inproprieties, or at least the appearence thereof, DO exist, and the

>> public perception is that they are far more common in private

>> practices than hospital outpatient clinics. This is because of the

>> assumption that the hosptial outpatient clinics has greater resources

>> and don't need to do anything questionable to attact patients. Fact

>> or not, truth or not, that is, I believe, public perception.

>>

>> It is perceptions and extreme statements that is, or at least should

>> be, at the heart of the discussion. I am not pro-cap, nor do I think

>> that hospital therapy centers always provide better can than

>> outpatient clinics --- so why are we discussing this situation in

>> terms of the cap having COMPLETELY negative impact. The fact of the

>> matter is that the cap won't impact nearly as many patients as we'd

>> as PT's against the cap might have the public believe, and GENERALLY

>> SPEAKING (I know there are a few exceptions) the ones that it does

>> impact are more likely to need more comprehensive care and broader

>> resources that (in my experience anyway) the hospital is more likely

>> to have.

>>

>> My point, again, and maybe I've simply communicated it wrong, is

>> almost exactly what yours seems to be --- that we should not only

>> focus upon how it's inappropriate and professionally offensive to

>> impose a cap on one clinical doctoring profession and not all (can

>> you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

>> Chiropractic Cap?) --- but also suggest that we focus our discussion

>> upon those situations where a patient might be affected. To do so

>> presents a far more professional argument than " the Cap is completely

>> bad and has no positive elements, " which is, in my opinion, a

>> dangerous game that we're playing. Otherwise, I fear we're going to

>> end up sounding a little less professional and a little less educated

>> than I believe our profession to be.

>>

>> Dr. M. Ball, PT, DPT, PhD

>>

>>

>>

>>

>>

>>

>>

>> Looking to start and own 100% of your own Practice?

>> Visit www.InHomeRehab.com.

>> PTManager encourages participation in your professional association.

>> Join

>

>> and participate now!

>>

[Guest guest]

Regarding: " If I sound like a cheerleader for private practice, I am. "

Please, be a cheerleader for quality, and for patient choice, but beware the

trap of embellishing the qualities of individuals based on the corporate

charter under which they work.

$5,000.00 per year is indeed a lot of CE dollars---even more so if you

consider the time away from work needed to spend it---but is that typical in

private practice settings? And more important, is that the end-all and

be-all of professional development? Our hospital therapists, in addition to

CE, take advantage of opportunities to share orthopedic rounds and visit

surgeries, have frequent face-to-face consultations with referring

physicians, engage in formal and informal peer-to-peer (PT, OT, ST,

physician, and others) education, and other such activities that would be

hard to duplicate in a private practice setting. Should I therefore tout

hospital-based practice as the de facto superior service? Of course not.

Just as the best practitioners will always seek quality wherever they exist,

likewise so will the best managers. Quality emerges from within the

individual, not from a corporate charter.

Regarding: " Capitalism works for a reason. "

Those of you who believe you are practicing in a capitalist system should

climb out from under your pile of charts and take a good look at the

third-party-payer monolith. As the list serve amply demonstrates, kadoidling

with third-parties and regulators has these days become much more than a

mere adjunct to practice. Third-parties are now the primary movers and

shakers, and our reactions to them define our forms of practice. They rule

us, and they rule our patients. (Once again, please support Healthcare

Savings Accounts!)

And last but not least, while I disagree with Mark Dwyer's implication that

a low profile (i.e. the profile of a therapist who has not demonstrated his

qualities by teaching or writing or the like) equates with less quality, I

wholeheartedly cheer his obvious personal commitment to quality, and exhort

others to follow his lead.

Dave Milano, PT, Director of Rehab Services

Laurel Health System

32-36 Central Ave.

Wellsboro, PA 16901

dmilano@...

Re: Re: Changes because of the caps

I don't recall making any statement about the ethics involved but I did

comment on quality of care. Iin thinking of the various PTs across the

country who I feel would render the best quality of care in an outpatient

orthopaedic sitting, almost all of the names that come to mind are private

practitioners. That's not to say that excellent therapists do not exist in

hospitals or other institutions but they certainly are not as common as top

of the line private practitioners. How many innovators of new treatment

methodologies have come out of institutions versus private practices?

Capitalism works for a reason. When there is financial incentive to better

oneself, you generally see a better quality of practitioner. On a personal

level, if I look at my continuing education allowance over my career

(courses, books, journals, audio media, visual media, etc.), it has

conservatively averaged $5K or more dollars a year. I don't know too many

institutions who are that generous with their employees, do you? I think

the more we invest time and money in helping our patients, the more

effective we can be as practitioners. If I sound like a cheerleader for

private practice, I am.

Re: Changes because of the caps

>

>

>> ,

>>

>> If YOU were offended, then I must have simply miscommunicated badly.

>> You've not been one to miss my meaning. Let me try again . . .

>>

>> I KNOW that not all private-practices operate in a " conveyor belt "

>> manner. I also am quite aware that we disagree as to where the

>> lesser quality of care is likely to occur. I KNOW that over the

>> course of my 10 year career, that I've worked short stents for some

>> less than ethical employers/bosses, and that because they tended to

>> be either corporates or non-PT owners of private practices, that I'm

>> a bit jaded.

>>

>> Either way you're missing my point.

>>

>> Inproprieties, or at least the appearence thereof, DO exist, and the

>> public perception is that they are far more common in private

>> practices than hospital outpatient clinics. This is because of the

>> assumption that the hosptial outpatient clinics has greater resources

>> and don't need to do anything questionable to attact patients. Fact

>> or not, truth or not, that is, I believe, public perception.

>>

>> It is perceptions and extreme statements that is, or at least should

>> be, at the heart of the discussion. I am not pro-cap, nor do I think

>> that hospital therapy centers always provide better can than

>> outpatient clinics --- so why are we discussing this situation in

>> terms of the cap having COMPLETELY negative impact. The fact of the

>> matter is that the cap won't impact nearly as many patients as we'd

>> as PT's against the cap might have the public believe, and GENERALLY

>> SPEAKING (I know there are a few exceptions) the ones that it does

>> impact are more likely to need more comprehensive care and broader

>> resources that (in my experience anyway) the hospital is more likely

>> to have.

>>

>> My point, again, and maybe I've simply communicated it wrong, is

>> almost exactly what yours seems to be --- that we should not only

>> focus upon how it's inappropriate and professionally offensive to

>> impose a cap on one clinical doctoring profession and not all (can

>> you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

>> Chiropractic Cap?) --- but also suggest that we focus our discussion

>> upon those situations where a patient might be affected. To do so

>> presents a far more professional argument than " the Cap is completely

>> bad and has no positive elements, " which is, in my opinion, a

>> dangerous game that we're playing. Otherwise, I fear we're going to

>> end up sounding a little less professional and a little less educated

>> than I believe our profession to be.

>>

>> Dr. M. Ball, PT, DPT, PhD

>>

>>

>>

>>

>>

>>

>>

>> Looking to start and own 100% of your own Practice?

>> Visit www.InHomeRehab.com.

>> PTManager encourages participation in your professional association.

>> Join

>

>> and participate now!

>>

[Guest guest]

Re: Changes because of the caps

>>

>>

>>> ,

>>>

>>> If YOU were offended, then I must have simply miscommunicated badly.

>>> You've not been one to miss my meaning. Let me try again . . .

>>>

>>> I KNOW that not all private-practices operate in a " conveyor belt "

>>> manner. I also am quite aware that we disagree as to where the

>>> lesser quality of care is likely to occur. I KNOW that over the

>>> course of my 10 year career, that I've worked short stents for some

>>> less than ethical employers/bosses, and that because they tended to

>>> be either corporates or non-PT owners of private practices, that I'm

>>> a bit jaded.

>>>

>>> Either way you're missing my point.

>>>

>>> Inproprieties, or at least the appearence thereof, DO exist, and the

>>> public perception is that they are far more common in private

>>> practices than hospital outpatient clinics. This is because of the

>>> assumption that the hosptial outpatient clinics has greater resources

>>> and don't need to do anything questionable to attact patients. Fact

>>> or not, truth or not, that is, I believe, public perception.

>>>

>>> It is perceptions and extreme statements that is, or at least should

>>> be, at the heart of the discussion. I am not pro-cap, nor do I think

>>> that hospital therapy centers always provide better can than

>>> outpatient clinics --- so why are we discussing this situation in

>>> terms of the cap having COMPLETELY negative impact. The fact of the

>>> matter is that the cap won't impact nearly as many patients as we'd

>>> as PT's against the cap might have the public believe, and GENERALLY

>>> SPEAKING (I know there are a few exceptions) the ones that it does

>>> impact are more likely to need more comprehensive care and broader

>>> resources that (in my experience anyway) the hospital is more likely

>>> to have.

>>>

>>> My point, again, and maybe I've simply communicated it wrong, is

>>> almost exactly what yours seems to be --- that we should not only

>>> focus upon how it's inappropriate and professionally offensive to

>>> impose a cap on one clinical doctoring profession and not all (can

>>> you IMAGINE a Medicare Medical Services cap? A Podiatry Cap? A

>>> Chiropractic Cap?) --- but also suggest that we focus our discussion

>>> upon those situations where a patient might be affected. To do so

>>> presents a far more professional argument than " the Cap is completely

>>> bad and has no positive elements, " which is, in my opinion, a

>>> dangerous game that we're playing. Otherwise, I fear we're going to

>>> end up sounding a little less professional and a little less educated

>>> than I believe our profession to be.

>>>

>>> Dr. M. Ball, PT, DPT, PhD

>>>

>>>

>>>

>>>

>>>

>>>

>>>

>>> Looking to start and own 100% of your own Practice?

>>> Visit www.InHomeRehab.com.

>>> PTManager encourages participation in your professional association.

>>> Join

>>

>>> and participate now!

>>>