APTA President: 'State the Obvious'
BOSTON-APTA President Scott Ward, PT, PhD, returned to the city of his birth to deliver the Presidential Address at APTA 2010 on Wednesday evening June 16. As professor and chair of the PT department at the University of Utah, Dr. Ward focused his talk on education-teaching policymakers and the public that physical therapy is a valued and necessary service in the evolving healthcare landscape.
The best way to begin is by stating what PTs already know.
"Imparting the obvious is the foundation of teaching," stated Dr. Ward, adding that Boston is a hub of PT education, with 7 programs in the city and 4 within walking distance of where he stood.
Dr. Ward outlined 4 key ways to leverage the power of the obvious:
- The human connection. There's been an undeniable push toward the de-personalization of health care, stated Dr. Ward. The connection that arises between physical therapists and their patients is what defines them as a profession. "Consumers come to us for a transformative experience," he said.
- Create a buzz. "The public must hear about us, from us," said Dr. Ward. The greatest source of good public relations is good service. Create a buzz with patients and with media-share patient stories and offer your expertise to news outlets and at community events.
- Physical therapy care is of value. Though it's obvious to many patients, PTs can't assume that the value they provide is obvious to regulators and policymakers. "The majority of comments I get from payers is related to documentation," declared Dr. Ward. Arm yourself with the facts and figures that support your services, and get to know the decisionmakers that shape payment policy.
- The power of numbers. Dr. Ward stated that with a membership 75,000 strong, the association's potential for meaningful change is limitless. "If we work together, we can use the obvious to dispel myth," he stated.
By stating the obvious, Dr. Ward said, you can bring physical therapy to center stage during this transformative moment in health care delivery. "People expect our every effort to get them better," concluded Dr. Ward. "State the obvious, then follow it up with action."
Daschle: 'Bright Future' for PTs
A packed house was on hand as former U.S. Senator Tom Daschle outlined the effect of the recently passed health care bill, and what it will mean to physical therapists going forward, during the opening keynote address of PT 2010.
"APTA has always been a remarkable participant in the health care debate," said Daschle, who sees a "very bright future" for PTs as the nation's health care model shifts from an illness-based, fee-for-service structure to one that emphasizes wellness and prevention. "The more we emphasize cost-containment, the more we'll see the value of physical therapy," said Daschle.
A supporter of the new health care legislation, the former U.S. Senate Majority Leader and author of the new book Critical: What we can do About the Health-Care Crisis said that while there are a lot of naysayers and doubters, the result will be a high-value, more efficient and affordable health care system. As the only industrialized nation without a universal health care policy, the U.S. currently operates under a hybrid marketplace of public and private payers, Daschle explained. It's resulted in three problems facing the populace:
- Access. Fifty million Americans have no health insurance, Daschle explained. And of those that do, 48 percent have inadequate coverage.
- Cost. In 1947, the year that Daschle was born, 4 percent of the nation's GDP was spent on health care. By the time his grandchildren were born, that number had risen to 16 percent. "This is unsustainable," said Daschle. "We've got a real problem."
- Quality. In the last 25 years, the United States had fallen from 11th in total life expectancy to 42nd. "We haven't applied best practices systemically," he said.
The new bill will lead to transparency regarding quality and cost, Daschle believes. So why has it become such a divisive topic?
The main reason is the role of government in health care. This is a question that cuts across party and philosophical lines, Daschle said. So is deciding on the size of the payment "pie" that gets distributed to providers. Finally, the sheer complexity of the health care sector makes it difficult to come to a consensus.
2014 will be the most pivotal year under the new plan, said Daschle, as state insurance exchanges will be implemented, all Americans will be required to have some form of coverage, and delivery models will begin to de-emphasize disease in favor of wellness programs and initiatives.
Daschle spoke of the new health care bill as a "transformational moment in our history" and suggested that future generations will look back on 2010 with the same appreciation afforded to past watershed moments such as the establishment of the Social Security system. But he said more work needs to be done.
"We're on the 30-yard-line," said Daschle. "We've got 70 yards to go. There will be incomplete passes, there will be fumbles, but we'll reach the goal line."
Rothstein Debate: New Delivery Models
The APTA honors the memory of Jules Rothstein, editor-in-chief emeritus of Physical Therapy, the association's professional journal, with an annual debate at the national conference. This year, four prominent speakers representing a range of practice systems spoke about innovative care models that can help position physical therapists for continued growth and success amid drastic changes in health care policy.
Under the new health care bill, "lots of providers will jockey for position," said panel member Alan Jette, PT, MPH, PhD, FAPTA, professor of health policy and management at Boston University's School of Public Health. "One issue we'll have to aggressively address is how to demonstrate [PT] value."
Dr. Jette advocated more aggressive funding efforts to launch major initiatives that explore where PT can make an impact, and where it cannot. He cited the National Institutes of Health and the Agency for Healthcare Research and Quality as two possible funding sources for comparative effectiveness research. "As a PT, we should be positioning ourselves to use some of that money," he said.
Colleen Kigin, PT, DPT, MS, MPA, FAPTA, chief of staff of the Center for Integration of Medicine and Innovative Technology (CIMIT), a Boston-based consortium of major teaching hospitals and engineering schools, outlined the service model at Massachusetts General Hospital (MGH) in Boston. Explaining that MGH is self-insured, as many major hospitals have become in order to cope with escalating premium costs, Dr. Kigin outlined the team-oriented position that PTs assume alongside physicians and other providers.
"Anyone can take a call from any patient," explained Dr. Kigin, adding that all providers are employees of MGH. Team outcomes are currently being tracked, and MGH cares less about the outcomes of each singular discipline than the outcome of the entire care team.
Panel moderator Gerard Brennan, PT, PhD, outlined a similar model at Intermountain Health Care in Salt Lake City, where he serves as director of clinical quality and outcomes. The challenge at a vertically integrated system such as Intermountain, which operates hospitals, surgical centers, doctors, clinics and home care providers, is how to bundle and pay for the services, said Dr. Brennan.
"Ultimately, the people who pay the bill will want to know the value," echoed Dr. Jette. "We've got to look beyond process, to outcomes."
"It's critical that we substantiate PT services," agreed fellow panel member Anthony Delitto, PT, PhD, FAPTA, professor and chair of the PT department at the University of Pittsburgh. "We just can't settle for, 'these therapists are great, we're so glad they're here.'" The panel outlined a number of data gathering efforts and plans for a widespread database of cost-effective interventions for conditions such as back pain.
Such initiatives will help standardize many of the wide-ranging approaches to common conditions among PT providers. "We have tremendous variability of care," said Dr. Brennan, which drives up the cost of physical therapy. "It's a problem."
"One thing we forget is that the patient will eventually make the decision on where to go," added Roger Nelson, PT, PhD, FAPTA, in closing remarks from the audience. Practice best evidence, said Dr. Nelson, and the public will help the demand for PT
services. "Patients will find the best provider."
Red Sox Docs: Treating Shoulder Injuries
One of the most anticipated continuing education sessions at PT 2010 was "Evaluation and Treatment of the Shoulder in Athletes Participating in Overhead Sports." It was a treat for the audience to learn from two true experts on the subject: Michael M. Reinold, PT, DPT, SCS, ATC, CSCS, and Thomas J. Gill, MD. Dr. Reinold is the head athletic trainer and assistant director of medical services for the Boston Red Sox, while Dr. Gill is the medical director for the Red Sox, in addition to his role as chief of sports medicine at Massachusetts General Hospital.
Both men expressed their excitement about presenting at the conference, a development made possible only because PT 2010 was held in Boston during a Red Sox homestand. The session took place the morning after a Red Sox victory over the Arizona Diamondbacks, on the same day that Los Angeles Dodgers slugger Manny Ramirez would make his much-hyped return to Fenway Park.
Drs. Reinold and Gill spent three hours discussing the unique stresses placed on the throwing shoulders of elite pitchers, as well as the intensive rehabilitation necessary to help these athletes return to full strength from injury. The presenters made significant use of biomechanical analysis and anatomical diagrams, also drawing several laughs from the audience as they related anecdotes from working for one of the most high-profile and historic teams in Major League Baseball. Keep an eye out for a full-length feature article about this fascinating presentation in an upcoming issue of ADVANCE!