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Disruptive Innovation In Physical Therapy: Part II PDF Print E-mail
Monday, 05 July 2010
White Rubik's CubeIn Part I, I discussed the issues of quality and value in the health care system (in general) and in physical therapy (specifically). Let me expand on that a bit, and then provide an innovative solution to the problems at hand.

A typical episode of care, in the current paradigm of what is “acceptable care” (note how I did not say “evidence-based care”) is 8 to 10 visits. As I mentioned earlier, this is considered by many to be “great care” and is even advertised as such. These same 8 to 10 visits are costing the patient, on average, anywhere from $64 to $80 per visit, with a total of $512 to $800 out-of-pocket for any given episode of care. This investment may not provide much value-added benefit nor quality, especially if evidence- and science-based strategies have not been implemented in competent self care strategies. Sadly, the disconnect between quality and value has become the accepted standard amongst clinicians and patients – for all the reasons that I outlined in Part I.

Add to this the fact that for every $10 spent on health care, $9 are spent on overhead. Yes, just $1 is spent on actual care, and even that is being lost in the quality/value debacle. But we also know that for every year of education, health care costs drop. So having people better educated in the process of their care makes good sense economically and culturally.

Seven years ago, my clinical practice moved from an insurance-based model to an out-of-network fee for service model. But what I have found over the years is that patients are so driven by “what their insurance covers or pays for” or “who is in or out of network”, that they fail to fully comprehend and consider the issues of quality and value.

A fee for service model can provide an out-of-pocket cost saving, though conflicting value systems remain. Innovation can provide quality, outcome, value, and cost-efficiency, but something radically different will be required to transform our current models. Let’s examine how a fee for mentorship model provides a value proposition that is revolutionary in how we view health care, physical therapy, and health in general.

Disruptive Innovation In Physical Therapy: Part I PDF Print E-mail
Friday, 02 July 2010

Problems are OpportunitiesHealth care is in dire need of transformation. The system as we know it has been built on a foundation of principles that have conflicting values. Whether it’s the reimbursement models or the practice patterns, or both, the concepts of “quality” and “value” have been lost in the mix. What has become the accepted standard of care and delivery has become outdated, and in the midst of it, the patient – the driver of all of this – has been forgotten.

In any other realm, we look to quality and value as two key elements of an exceptional customer experience. A free and open marketplace fosters this. Consumers critically examine cost, quality of service, and results in their decision-making process for just about everything – cars, homes, education, you name it. Except health care.

Patients have learned to accept the gross failures and inadequacies of the health care system. Are patients satisfied with their care? Sure. But are their expectations of this “accepted standard” really at a high enough level? Or are they satisfied with something less simply because they have been told that that is the accepted standard?

This becomes all the more apparent in the world of physical therapy. When there are clinicians proclaiming that “first class service and results” create “the top physical therapy clinic for patient satisfaction” – and then stating that the “average length of stay is 10 visits – guaranteed” – I shake my head in disbelief. When 10 visits per course of care is considered “great care”, I have to wonder about what has become the accepted standard these days.

And there is plenty of finger-pointing by the clinicians at the insurance companies. It’s their fault for such low reimbursement rates, right? On the surface, there are many instances in which the finger-pointing may be well-deserved. But when you point a finger, as they say, four point back at you. The clinicians are as much to blame as anyone, and much of that has to do with a simple lack of innovation at a far deeper, systemic level. It starts with the clinician, their product, and their means of delivery.

Transformation requires a deeper level of understanding of the systemic problems, so let’s start there first.

BlogTalkRadio 7/6/2010: New Models Of Health Care Delivery PDF Print E-mail
Thursday, 01 July 2010

Join me on BlogTalkRadio on Tuesday July 6, 2010 at 8:00 pm central time for the latest episode of "Consumer's Guide To Health".The health care system is facing a number of problems. If it's not a question of cost, it's a question of quality. And if it's not a question of quality, it's a question of accessibility and of value. The future of health care will see not only an evolution towards competent self care, but it will also see innovative changes in how health care is delivered.

This episode's special guest is Dr. Sidney Robin, a family practice physician in Austin, Texas and owner of Austin Concierge Medicine.

The BlogTalkRadio call-in number is 646-929-1567. You can listen online at and also download this and previous episodes here as well.

Join us for the discussion!

BlogTalkRadio 6/8/2010: Who Needs Evidence? PDF Print E-mail
Tuesday, 08 June 2010

Join me on BlogTalkRadio on Tuesday June 8, 2010 at 8:00 pm central time for the latest episode of "Consumer's Guide To Health". The phrase “ evidence-based medicine” is pervasive in health and health care now. As the phrase becomes more common, there seems to be a growing chasm between those that utilize the scientific method, and those that don’t. It’s creating a rather intriguing problem for patients and practitioners. This episode will discuss the need for evidence and it's importance in competent self care.

The BlogTalkRadio call-in number is 646-929-1567. You can listen online at and also download this and previous episodes here as well.

Join us for the discussion!

We Don't Need No Stinking Evidence - Or Do We? PDF Print E-mail
Wednesday, 02 June 2010

Anything you say may be taken down and used as evidenceThe phrase "evidence-based medicine" is pervasive in health care now. As the phrase becomes more and more common, there seems to be a growing chasm between those that utilize the scientific method, and those that don't. It's creating a rather intriguing problem for patients and practitioners.

In one corner, we have those that are utilizing evidence-based strategies in the care of the patient. Using the scientific method doesn't eliminate what many call "the art of health care". The clinician still has to have clinical reasoning skills (which are deeply rooted in the scientific method) and the ability to use their communication skills effectively to establish rapport with the patient.

In the other corner, we have the "gurus". These are the people that will tell fellow providers that science has yet to explain what they do and besides, it doesn't matter anyways. Experience is critical, and there are plenty of stunning anecdotal results that make it all the more obvious. The "gurus" are the ones armed with methods that have minimal scientific plausibility as a foundation. And when speaking to other practitioners eager to learn their "methods", they will be the same people that will proclaim that one could be so lucky to attain their level of understanding, unless of course you want to take their 3 week course and pay a few thousand dollars to do so.

And though we might have once thought that the gurus were exclusively found amongst practitioners of "complementary and alternative medicine", they are now rampant amongst "mainstream" health care providers (such as physicians and physical therapists).

But here's the problem: you can't live in a world in which you selectively choose when you want to live with evidence and science, and when you don't. You cannot ride the coat tails of science while advocating for the cult of personality, mysticism, or the power of the placebo.

So do I need evidence? And why does it matter anyways?

Tags:  health care physiotherapy mehanisms and principles
Cycling, Doping, And The Perceived Limits To Human Performance PDF Print E-mail
Sunday, 23 May 2010
Lance ArmstrongImagine this: more doping claims in the world of cycling. At this point, there are three things we can count on in life - death, taxes, and allegations of drug use in cycling.

The question has reared it's ugly head once again: has Lance Armstrong been cheating all these years? Floyd Landis is the latest in a long line of people to point the finger at him. But before you even think of passing judgment, there are some rather important pieces of this puzzle that lend a great deal of context to what is becoming a made-for-TV-reality-show.Or a circus.Or both.

I'll be the first to profess openly that I am a fan of cycling. I was introduced to it in my youth, and watching the Tour de France on TV has been an annual extravaganza that closely resembles March Madness in it's ability to draw my attention. So it's safe to say that I come into this discussion with a love of cycling.

I think it's also safe to say that when discussing the issue of doping in cycling (or any other sport), we need to consider the context of the debate, the personalities involved, and the motives underlying the debate. We need to utilize the sports sciences research, and we need to examine our own belief systems. More on that later.

But back to Lance Armstrong. Over the years, Armstrong has faced accusations from a number of people that have been close to him in the cycling community.The most recent, Landis, has a rather intriguing and perhaps sordid tale. Here's the storyline:

Tags:  issues sports commentary
BlogTalkRadio 5/25/2010: Training Principles For Health, Fitness And Performance PDF Print E-mail
Friday, 21 May 2010

Join me on BlogTalkRadio on Tuesday May 25, 2010 at 8:00 pm central time for the latest episode of "Consumer's Guide To Health". Whether you're new to a fitness program, or trying to improve your performance, the principles that provide the foundation for your training remain the same. This episode will provide information on setting goals, training principles, and how to apply these principles to your own health, fitness, or performance program.

The BlogTalkRadio call-in number is 646-929-1567. You can listen online at and also download this and previous episodes here as well.

Join us for the discussion!

Three Important Consumer Issues In Physical Therapy And Health Care PDF Print E-mail
Thursday, 13 May 2010
hi qualityNot so long ago, in an infomercial or two, we were provided some of the finest observations of the state of the union - by none other than Ross Perot.

For those who have forgotten, while using his pointer and hand-held charts, he resolutely stated that "In America, we have a problem". He may not have been talking about health care specifically, but he certainly could have been.

Consumers have somehow been lead down the garden path in the discussion of quality, cost, and access in health care (including allied health professions such as physical therapy, chiropractic, and alternative therapies). In any business realm that we can think of, our task is to find the greatest quality of product or service at either an affordable price, or a price that we feel is directly related to the quality of the service. But in health care, the system is currently driven by some very anti-consumer principles.

As Dick Cavett once noted, "As long as people will accept crap, it will be financially profitable to dispense it". Health care is no different. So what are the underlying mechanisms and motivators that are currently working against the health care consumer?

Tags:  healthcare consumer physical therapy
BlogTalkRadio 5/11/2010: Social Media And The Health Care Consumer PDF Print E-mail
Tuesday, 27 April 2010

Update: Due to circumstances beyond our control, tonight's episode of "Consumer's Guide to Health" (and interview with Dr. Eric Robertson) has been canceled. It is rescheduled for Tuesday May 11 at 8:00pm central. Hope you can join us in two weeks for what should be a great episode.

Join me on BlogTalkRadio on Tuesday April 27, 2010 at 8:00 pm central time for the latest episode of "Consumer's Guide To Health". Social media and Web 2.0 are changing the way that patients and health care providers interact. This episode of "Consumer's Guide To Health" will examine social media and how Web 2.0 tools and sites apply to the health care consumer.

This episode's special guest is Dr. Eric Robertson, PT, DPT, OCS. Eric is a physical therapist that specializes in orthopaedic manual physical therapy. He is a faculty member of the PT program at Texas State University in San Marcos. Eric's main area of interest beyond manual physical therapy includes leveraging web technologies to improve evidence-based practice. He also has a blog entitled PT Think Tank - critical observations of health, science, and the physical therapy profession.

The BlogTalkRadio call-in number is 646-929-1567. You can listen online at and also download this and previous episodes here as well.

Join us for the discussion!

MDT: A Powerful Tool With Athletes PDF Print E-mail
Sunday, 25 April 2010

Roman bronze reduction of Myron's Discobolos, ...I have spent most of my career working with athletes, be they recreational or elite. They have run the gamut from endurance sports to power sports, and all points in between. Over 12 years ago, I completed the highest level of training in the McKenzie Method. Since then, I have been one of the few practitioners worldwide that has been actively applying this approach to a sports population.

With all of the approaches to care available, especially with athletes, why head down this path?

First of all, the McKenzie Method has a very intuitive "fit" with an athletic population. First and foremost, the active populace is typically in the "mind set" of self-treatment and training. Athletes, be they recreational or elite, seek treatment methods that are active and patient-centered. These patients are highly responsive to such measures and typically prefer approaches that facilitate "empowerment" and self-treatment.

The McKenzie Method also provides a great screening process - to understand the mechanical loading strategies, directional preference, and thus safe aspects of training that can be resumed early on in the injury recovery process.

The sports medicine world is traditionally very "pathology-driven", so my first forays with McKenzie into this world were like speaking a foreign language.

Tags:  McKenzie sport injury
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