Also, Jette and Jewell just published a great article called...
Use of quality indicators in physical therapist practice: an observational study
...in the April PTJ at http://1.usa.gov/JT4wJH

They found that physical therapists measurement of Body Mass Index (BMI) was low:

Only 3.6% of 2,221 physical therapists in the survey performed BMI measurements.
84% of physical therapists perceived BMI measurements as burdensome.
69% of physical therapists believe that BMI measurements DO NOT have good literature support.

Disappointingly, Jette and Jewell's findings indicate that physical therapists have a long way to go before assuming a doctoring role in primary care.

Thanks Kyle,

I, for one, intend to be a voice (in a white coat) encouraging people to reduce portion sizes.

I've also got a double beam scale that I can start using to calculate BMI at the first visit - that is one of the PQRS Quality Metrics that outpatient physical therapists can receive bonus payments for another 18 months.

Thanks for commenting,

Tim

Thanks Rick.

I'll probably start simple in the clinic such as with a screening question like "Do you control your portion size?"

An evasive answer like "Oh, I only eat healthy carbs" might be a tip-off that my patient consumes too many calories.

Tim

Great response - you're right, that was more than a comment.
Tim

Thanks Jeff for commenting - you're right.

I think, ultimately, patients will be better off, too, when all physical therapists provide basic screening services in a primary care role.

Tim

Thanks Damon,

Good luck to Pennsylvania in your fight for fair PT Copays in 2012.

Tim

I agree. Calling it "direct access" is confusing. But, you CAN see a Medicare patient without a referral (no matter what state). Just get the POC signed.
Tim

Medicare IS a gray area because the patient access requirements vary so much based on state practice acts, which may be MORE restrictive than Medicare, but not less.

Tim
www.PhysicalTherapyDiagnosis.com

Selena, you're right - that's why I put in the disclaimer in the original post. My intent was to emphasize that physical therapists in Florida often fail to take advantage of what is often called "limited direct access".

Florida's political discussions often revolve around the need for FURTHER state-level, direct access legislation - despite the fact that, anecdotally, I find that MOST physical therapists tell their patients "You NEED a physicians' referral to obtain your Medicare physical therapy benefit".

Like you said, the referral for PT is not necessary, even though the physicians' signature IS necessary.

We do the Medicare Eval, write the Plan of Care, hand it to the patient and tell them "IF your physician signs this POC then Medicare will pay for your PT".

Like I said, I've never been burned.

On the rare occasion the physician failed to sign our POC, we have assisted the patient in finding a new physician :)

Tim Richardson, PT
www.PhysicalTherapyDiagnosis.com

Joe,

I agree we don't want to follow chiropractors down their road.

But, the demand to replace physicians with physical therapists does not come from within physical therapy, nor from physical therapist professional associations, nor from physical therapist academic programs nor from physical therapists' intelligentsia.

It comes from hospitals: http://bit.ly/A1uyuP

The highest-cost settings in healthcare are pushing scope-of-practice boundaries that many state associations are too timid to try: http://bit.ly/yoZseW

Physical therapists and nurses can now render pathologic diagnoses using clinical decision rules that are MORE safe and MORE efficient than a physician's unaided diagnosis: http://bit.ly/xtBn1X

"Physical therapists replacing physicians" is a simple message.

Its a brand we can sell because hospitals and society are buying that right now.

Tim Richardson, PT
www.PhysicalTherapyDiagnosis.com