Sunday, December 21, 2014

Future of Physical Therapy 2015 (Part 2)

Welcome to Part 2 of Future of Physical Therapy 2015.

If you wish to look back further, you can find Part 1 HERE!



So, where do we go from here?

2015 - It's Time To DisruPT!

Well, as with all things when sustainability begins to waver, the inevitable is coming around the corner: DISRUPTION! Disruptive innovation classically occurs when industries can no longer keep up with the pace, volume, costs, and burden of their current patterns of operations. Healthcare is absolutely ripe for disruption.

To accurately approach disruption, we must appreciate that disruption usually occurs as a result of combinations and conveniences. In the 1950's, it wasn't a better vacuum tube that disrupted the television industry. Rather, by offering portability (something TV sets were incapable of doing through vacuum tubes), transistors made it possible for TVs to be more than a fixture -- allowing people to use TV in places, times, and situations never before available. In fact, it also made TVs available to consumers who never before were able to afford them as well!

Healthcare needs to be seen through a similar lense. We can't disrupt healthcare by doing what we've already been doing better. Truth be told, what we've already been doing IS NOT WORKING! Why try to improve on it? It's time to run a different route.

Gone should be the days of healthcare seen as reimbursement, profit, and service based billing. Healthcare should be judged and paid for through cost savings and value added outcomes.

What do I mean by this? If a specific service performed by a firm directly saves $5 million dollars for ten thousand beneficiaries in a health system, a significant segment of those savings should go towards payment of the firm's services. Moreover, the positive consequences of keeping an entire population healthy -- the economic boost, improved productivity, etc., such should also be measured and the firm proportionately rewarded for the value they have returned to society at large.

2015 - Prime Opportunities
So what are the opportunities before us? Resource management, big data, prevention, minimizing risk factors, childhood A-B-C's (getting them living healthy as early as possible), the baby boomers, necessary/unnecessary, population, patterns, primary care, segments and trends... these are the buzzwords for 2015. The reason these are the buzzwords for 2015 is because this is where the accountants and analysts have determined the most financial opportunity for cost saving and change now resides.

While it can be noted that some practices are beginning to mature in this space outside of billing for units in the clinic, I think there's still a general stigma to this shift. It is a stigma that we REALLY need to get over and away from as a profession. Healthcare is a service and this service has evolved far beyond the bedside, operating room, diagnostic suite, and treatment table. It is as if we have 2015 capabilities but are operating out of 1995 mentalities; we need to get beyond this barrier and into a place where we can utilize our skills to the max, bringing all the benefits we offer accessible to the public.

So! Let me say it again: Being a clinician is NOT the ONLY way to be a PT. More importantly, shifting our focus away from hands on clinical should not be seen as abandoning the profession. It is not treason nor betrayal for PTs to serve outside of the clinical realm.

Just as the nursing profession just disrupted healthcare a generation ago by providing adjunct expertise to physicians as a more manageable resource and cost pool, PTs need to be thinking in similar ways relevant to this current generation.

I've observed and strongly suggest that PTs who wish to be part of the disruption look into opportunities where we can be a part of resource management, big data, early intervention, and portal access (ie. telehealth, mobile apps, biometrics, etc). After all, can you REALLY survive by billing units while said units are worth less and less each year? NO! We have got to become more, do more, and seek to bring value outside of our clinical walls. It is here I hope to see PT practices approach big business, big contracts, and large population portals en masse to serve in preventive programs, early intervention, and primary care roles.

It's a good time to pay attention to the forest.

Similar opportunities are present in the inpatient setting. Fall prevention, reduction of employee work related injuries, physical screening for discharge planning, diagnostic support in the emergency department, unskilled labor management, and case management are EXCELLENT areas to which PTs can serve with distinguishment.

Actually, I foresee the most valuable role for PTs (inpatient and outpatient) as a type of primary care case management of musculoskeletal concerns for all settings in both clinical care and resource utilization roles.

To these points, DPT programs need to add to their curriculums business studies, particularly that of marketing, supply chain, operations management, and analytics.

If all our schools do is teach our students to be clinicians, when they graduate that is all they will know to be and feel it is important to be.

If we are to disrupt healthcare; if we are to become more, to evolve into something significant on the largest of scales, we need to empower our students to think outside of the clinical box; we need a generation of leaders in thought... we already know that they will take action.

2015 - Problem Children

When I take a look at the biggest problems in healthcare, I feel that much of it occurs because of the bullwhip effect - a term from supply chain management. Essentially, miniscule errors upstream cause tremendous variabilities and errors downstream. Think about all the missed musculoskeletal diagnoses you've caught; acute PTs, think on all the strokes you've screened out when CT scans said "negative"; consider the sheer number of prescription of drugs and inappropriate referrals to specialists... all these, in my humble opinion, are the result of a process based bullwhip effect -- seeded in outdated practice patterns, poorly applied data, and using a sift rather than going to the source. Keeping to our current path means subjecting ourselves to a masochistic epidemic of inappropriate utilization in healthcare services; drugs, inpatient stays, and redundant office visits are only the tip of the iceberg.

We need to honestly ask ourselves some rather ugly questions:
  • Do I really need a physician to educate me on how an antibiotic will be ineffective for the flu symptoms I have?
  • Is a physician really the best clinician to perform my PHYSICAL?
  • How about prescribing pain meds to... everyone?
  • There are problems inward as well: How "skilled" is it to turn on a diathermy machine and leave a patient for 20 minutes? Oh, and don't forget to use that NuStep. After all, your administration told you to do it, right?
  • Since we're in the month of December, how ethical is it to scare an assisted living resident to stay for 100 days in the "health center?" After all, they don't want have to go through the trauma of going back to the hospital, now do they? And, even if they do, they still have 100 days come New Year's!
  • How much is billing neuro-re-ed really helping our bottom line in the long run?
  • Is it really worth fighting for the table scraps of Medicare dollars?
  • How about chop shop clinics where aides do all the ther-ex and clinicians do 8 or 23 minutes of whatever else?
  • Home health extensions ad nauseum?
Like I said, I'd be bringing up some ugly topics. I also bring solutions. The way I see it, the ugliness exists because people have been brought to the brink of financial disaster in a system that is filled with erroneous processes.

Through all this, many experts and industry leaders are turning to "big data" for clarity. Identifying trends, managing patterns, etc. While I strongly agree with this strategy of digging deeper to find the roots, I challenge some in their methodologies. Personally, I'm not a fan of the term "big data" for healthcare... at least not yet. I think right now, it is the time for SMART DATA. Currently available data in healthcare can get problematic when it is "big" because it can quickly obscure, eclipse, and make murky the commonly obvious, otherwise elucidated by what many have felt (myself included) is best termed as "smart data."

(A topic for another time.)

In any case, for healthcare, data can be quite unclear because no one has truly been honest with the situation and themselves. This has caused the industry to sacrifice clinical excellence, best practice, honest outcomes... betraying the patient experience. Those who have had found the secret, however, they aren't sharing -- not yet, anyway ;)  And that's okay! It is there competitive advantage. Soon, it will be to their best interest to share and stand on the pedestal as industry leaders in disruptive innovation.

I would suggest that clinical excellence with the patient's best interests placed in priority and under the authority of respective content experts will bring truly meaningful and valuable observations to light. Through such analytics, solutions can be synthesized which are applicable in scale and breadth -- these are smart solutions using smart data which will produce satisfied patients, satisfied providers, and favorable finances.

2015 - Key Strategies to Successful Innovation
As we all know, change is inherently met with opposition no matter what, where, or when it occurs. Why? Well, it's not that the any given majority are ignorant, backwards thinking, or archaically minded. The resistance to change on the larger scales occurs because of organizational behavioral factors. Primarily, what has been termed the "innovator's dilemma" causes organizational behavior to favor what has always worked. After all, our core competencies is what made us great to begin with, right? This can quickly lead to a group think of: "Why fix something that isn't broken?"

I know I've said it before on Twitter...(finding it right now):
So what needs to occur to ensure that a great idea isn't snuffed out by the process and organizational values already in play?

The answer and more, coming up in Future of Physical Therapy 2015 (Part 3)

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