Treating the right patient at the right time with the right intervention for optimal outcomes seems to be one of the major goals to achieve across the board for all medical providers. If we break this goal down into 4 parts, as physical therapists we need to change our mindset.
Larry has written about Thinking Traps a couple of times this year. As I look at the evidence being published over the last 5 years, I believe we will definitely need to change our mindset in order to meet the very broad, major goal mentioned above.
“Treating the right patient” brings me to immediately think of physician owned practice situations. Due to the lack of autonomy in this situation, physical therapists may not truly be treating the right patient. If we look outside the box and consider a bigger picture, every patient that walks through a physician’s doors may not be the “right patient” for that physician. Evidence suggests physical therapists have a much greater role then physicians when it comes to addressing musculoskeletal issues. Those patients are not the “right patients” for physicians. The current model increases costs and reduces the likelihood for optimal outcomes.
Evidence is suggesting that patients aren’t receiving services from physical therapists “at the right time.” The current model underutilizes physical therapists. Underutilization reduces optimal outcomes and increases cost. I would even be so bold to suggest consumers aren’t even aware of the role physical therapists can have for their problems. Thus, consumers aren’t even choosing physical therapists which also reduced the opportunity to receive care “at the right time.” (Although really small n values, I believe the table is representative of what is typically seen across the nation for states with direct access.)
If the patient isn’t accessing the right provider, well, all bets are out that the “right intervention” is even within the treatment plan.
And lastly, “optimal outcomes” feels like lipservice at this time. More work needs to be done to better define “optimal outcomes.” “Optimal outcomes” is being severely limited to dollars spent and typically analyzed via claims data. The whole medical world needs to step up this area (our profession included). Quality needs to be measured and reported (and I’m not talking the PQRS crapola).
I’d like to get back to my original statement: We need to change our mindset. Look at each of the 4 aspects of what it takes to meet the overall goals of treating the right patient at the right time with the right intervention to achieve optimal outcomes. I’m going to assume a model that seems to have to emerge is one where we are elbow to elbow with physicians. We may need to reconsider the immediate gut reaction of “no way” by immediately assuming a conflict of interest situation when employed within a physician practice. (By the way… there are less and less stand alone physician clinics – the majority are selling out to large systems in response to fear and anticipated upcoming changes in payment models.)
If we really want to serve patients so they access our services at the right time to receive the right intervention to achieve optimal outcomes, we also need to reassess our current models, our current practice settings and current thought processes with regard to appropriate interventions. To actively implement evidence, the changes required include moving into physician offices, emergency departments and urgent care settings. Our role differs in these situations. We need to pull upon on our differential diagnostic skills, we need to be a bit quicker, we need to spend a chunk of immediate time educating, we need to manage care from afar with less visits and consider telemedicine to meet the needs of patients.
How do you feel about changing your mindset in how you meet the needs for patients because our traditional model of care is suboptimal on so many levels?
Until next time,