Thanks for your thought, Joe. We have plenty of standardized outcome measures that work perfectly fine for individual patients and yes, PSFS is definitely one of them.

The issue... it is highly likely that if outcome data is to be included on claim forms, the payers will data mine. When data mining begins to happen, they will notice that for the exact same ICD-9 code that some patients make huge gains in a short amount of time and others take way longer to make less gains in a longer amount of time. Potentially the payers will then want to regulate the amount of change required to occur in a defined amount of time.

We can't stand back and allow a trainwreck like this to happen. There are quite a few variables that impact the outcomes and if those variables are not taken into consideration apples and oranges are being compared. I honestly don't believe we even have a reasonable system currently existing for the 65+ age group because the current systems I have seen do not merge performance data with self-report measures. For example... a community dwelling 70 year old female with low back pain who is able to ambulate faster than 1 m/sec would probably have better outcomes than a similar female who ambulates slower than 1 m/sec. There may be differences in individuals who do or don't have dementia. Certain medications may affect outcomes. All of these little nuances aren't taken into consideration when reporting an outcome measure.

A standardized measuring system for all patients will be a fail... RTI and their DOTPA project will be a fail.

Hi Erson, Ross & Boissonnault had a 25% self-referral rate also. Another paper I read at the end of last year with a small sampling of clinics in the US also had a small self-referral rate. I wasn't completely you out with regard to why there is less self-referral rates. Our profession isn't taking one bit advantage of a situation that is beneficial for consumers.

With self-referral the number that matters is new self-referral patients. The higher the percentage would mean consumers choosing physical therapists.

Excellent on getting out in the community, building awareness, educating and letting consumers know they have another choice! Actually, they have an excellent choice when they are injured - physical therapists. Athletes are loyal and once you get a couple of them and do what only you know how to do best... word will spread among them! Your self-referral rates will definitely increase!

I'm going to be completely blunt. Physical therapists do NOT have direct access in Medicare. There has been a Medicare Patient Access to Physical Therapists Act since 2005 (from what I can find). I don't believe there is currently an active bill introduced on this particular issue.

I believe anyone hanging their hats on a signature on certifications and recertifications is potentially running a risk. If I were an auditor, I would not interpret a signature on a cert or recert as proof that a patient was under the care of a physician or nonphysician.

Some states are WAY less restrictive than Medicare. Some states have direct access meaning a patient can walk through the doors and a physical therapist can do what a physical therapist does without any extra hoops or requirements to meet.

Your are skating in a gray area stating physical therapists have direct access in the Medicare system. A patient is required to be under the care of a physician in order for payment of services. This is established via a referral. "Payment is dependent on the certification of the plan of care rather than the order, but the use of an order is prudent to determine that a physician is involved in care and available to certify the plan." http://www.cms.gov/Medicare/Billing/TherapyServic... PDF page 157

Sadly, this isn't the best option. Deciding and mandating a set amount of physical therapy isn't a patient centered response to this problem. I have experienced a few patients that I would never, ever provide 12 weeks of physical therapy. We need to be able to think and justify. In light of the therapy cap... unnecessary services increase cost too. We need to scream for the right patient at the right time... not every patient for a defined amount of time. This mandate is subservient in nature... we are professionals and we should be able to provide insight in whether physical therapy will provide successful outcomes or not. If we don't think so, we should have the ability to say, "no" to providing services.

Now that adds a whole different twist! Accountability with a threat of lack of reimbursement for services. I'm really not sure if negative consequences is the best option for motivating...but definitely an interesting thought.

Louis, please do not misread my thoughts. Okay, your blog post had some yike moments for me - I'd LOVE to have free access to a fitness facility (especially if it had a lap pool) - but the coolest aspect was learning your thoughts on what it was that changed your behavior. Your candid sharing gave me insight into some aspects of motivation and how your experience just might be able to help others. As a physical therapist, it sometimes seems that I am asking the world of my patients. I will actually be really interested in learning if you continue with the exercise addiction OR if you plateau and then get bored with it. I'll message you out of the blue via Google+ to learn...

Too bad there isn't a way for you to talk to Lon up there... I do think little reminders via the computer system like Lon is mentioning might help people to get out of static postures while on the computer.

I will have to remember that... I'm not familiar with this book. Thanks for sharing, Randy.