Finding Solutions

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By Stacy M. Menz, PT, DPT, PCS

This issue’s theme, “Focusing on Solutions: Overcoming Obstacles,” is an exciting one. I can directly relate to it as one of our company values is “Solution Oriented,” and it is one that profoundly resonates with me. Our philosophy is that if you bring up a problem, you also have to come with a solution. Having the staff member think about solutions opens up possibilities and takes the focus off of the problem. They begin to become accountable for where they can make a difference as opposed to being a passive participant at work.

I once attended a seminar where we performed an exercise called “Intention/Mechanism.” The purpose of the exercise was for everyone in the room to get from one side to another but by using a different mechanism. For instance, once someone had walked across the room, walking was no longer an option as a solution. The result was an unlimited number of mechanisms (solutions) to get across the room as long as our intention (goal) was clear. By focusing on the solutions, the obstacles diminished in size, whereas when focusing on the obstacles, they loomed larger and blocked possibilities.

Another practice that I use regularly is to brainstorm solutions to what seems like an insurmountable obstacle. It again takes my focus off the obstacle and allows me to think in terms of possibilities. I do not sensor myself when I am performing this exercise. I list every solution that pops into my head, regardless of how insane or improbable it seems. By not censoring myself and putting down every crazy idea, I have often found that the craziest ideas can spark another idea that is actually workable. If I had ignored the crazy idea, I might never have come to the workable solution.

In the ever-changing landscape of health care, we have an opportunity to focus on the solutions and continue to move and change even if it is baby steps or sideways steps. Movement allows a change in perspective and opens up the opportunity for new solutions to arise. If we stay focused on the obstacles we might find ourselves “stuck” in a position where we never take a next step.

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We Owe It All to Our Moms!

By Don Levine, PT, DPT, FAFS

The Marketing and PR Committee would like to acknowledge all the dedicated mothers who work in our profession. We would also like to remind our members that it is mothers who make the overwhelming majority of decisions regarding the health care of their families. For that reason, we urge you to plan to take time to celebrate moms in the coming month—and do not forget to celebrate all the mothers in your practice!

Celebratory Ideas
There are many ways to shine a light on the moms who are patients, parents, children of patients, or our employees. We will provide a few here, but we are sure that many of our members have celebrations of their own. If so, please share!

Say It with Flowers!
This is an easy one, but always appreciated. Present your moms with a flower to take home.

Monday Brunch!
Celebrate with food! This could be either the Friday before or the following Monday.

Discounted Services!
Many practices provide services beyond physical therapy. If you have massage, personal training, pilates, or yoga, offer a Mother’s Day special with a discount for these services given to your special moms.

Nutritionist!
While a few practices may employ a nutritionist, many do not. However, what a great way to collaborate: Find a local nutritionist who would like the exposure to your client base and see if they would provide a day of free or discounted services at your practice.

Donate!
Most practices are contacted at least weekly to donate to different causes. We recommend that you develop a yearly “giving” plan, and one of those opportunities could come during the month of May in which you donate to a cause in the name of all the moms in your practice and community.

Spread the love!
Remember, whatever you do to celebrate the moms in your community, make sure that your efforts do not go unnoticed. Your social media plan for the month should highlight the activities in your practice as well as bring to light the celebrations going on in your community.

The Marketing and PR Committee is excited to provide members with tools and tips to improve their efforts in promoting their practices. Look for more information on the PPS website, in the weekly e-newsletter, and in future editions of Impact magazine.

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Don Levine, PT, DPT, FAFS, is a member of the PPS Marketing and PR Committee and Co-Owner of OPT Physical Therapy, with multiple locations in Rhode Island and Massachusetts. He can be reached at dlevine@opt-ri.com.

Overcoming Obstacles and Finding Solutions

By Susan Nowell, PT, DPT

“Being busy does not always mean real work. The object of all work is production or accomplishment and to either of these ends there must be forethought, system, planning, intelligence and honest purpose, as well as perspiration.”—Thomas Edison

As an undergraduate student in the sciences, I deliberated for months on whether I should pursue postgraduate studies in molecular biology or physical therapy. I finally concluded that the physical therapy profession embodied my three primary passions and work skills as a researcher, a teacher, and a coach. Now, 15 years later, with over a decade of experience in the field, I would add a fourth role to the list: innovator.

Innovation, in its various forms, has been the cornerstone of advancing the fields of medicine and science for years. We could literally cite thousands of historical examples in which great leaders overcame adversity to drive society forward. Thomas Edison, an archetypal innovative figure in U.S. history, encountered numerous obstacles on his road to groundbreaking inventions. Comfort breeds shortsightedness. Contrarily, adversity and discomfort can serve to broaden awareness; they drive the search for better solutions. Innovation, at its best, is systematic implementation of a new solution to an existing problem.

In my opinion, there are two main aspects of the current health care climate that make running a private practice feel adverse: (1) the current reimbursement-dictated revenue paradigm, and (2) the potential dilution and misrepresentation of therapeutic language among the broader fitness industry. To quote Impact contributor Janet Lanham, RN and revenue cycle management expert, “In the old days (like the 1990s), you opened an office, saw patients, submitted a claim, and got paid. Easy!” That is definitely not the case today. With Medicare implementation of Sustainable Growth Rate (SGR), Correct Coding Initiative (CCI), and Physician Quality Reporting System (PQRS) requirements, we have seen subsequent reductions in reimbursement rates, an obvious challenge to clinic revenue and survival.

On top of the reimbursement challenges, we are confronted with growing competition from other health care and fitness industry professionals. We live in a constant inundation of fitness information on the web, in social media, and printed in health magazines. This leads to the potential dilution, misrepresentation, or misuse of the therapeutic terminology and treatment approaches we use. I personally find this unnerving and overwhelming. It is no wonder many private practice physical therapists echo concern over the potential encroachment on our profession.

Innovative concepts previously discussed include the implementation of clinic wellness programs, the growth of physical therapist–directed corporate employee health programs, and the development of physical therapy mastermind groups as collaborative problem-solving entities. I think we can take these innovative concepts even further to delineate our leadership as health care entrepreneurs. I believe we have the clinical knowledge and expertise to grab the lead in designing exercise products, developing sports-specific functional exercise programs, and collaborating with the tech world to pioneer new ways of streamlining nonproductive or nonreimbursable workload. An increased focus on tangible innovative tools will only strengthen our foothold in the health care industry and likely lessen our reliance on the current reimbursement-dictated revenue paradigm.

A good example of a physical therapist taking the innovative lead to design and patent a new exercise tool for physical therapists and other fitness professionals is the founder of CoreAlign, Jonathan Hoffman. Throughout his career, he worked as the head physical therapist for several European professional basketball teams, Israeli basketball and tennis national teams, and for the Association of Tennis Professionals. Inspired by his own athletic challenges and work in hospital rehabilitation and sports team settings, he created the CoreAlign device in 2004. The device encourages vertical posture for the majority of movement patterns. Many of the exercises promote core stability with functional movement patterns. The method was then transferred to Balanced Body, Inc., from California. Since then, together with the Balanced Body international team Jonathan has been teaching the method to movement-based professionals on an international level.

From my own experiences as an ultrarunner, a competitor, and a physical therapist, I have developed a specific set of training tools and running programs for runners participating in multiday running events. My approach involves a focus on injury prevention and awareness, which I believe separates my expertise from that of a personal trainer. I periodically travel to work as an onsite physical therapist for off-road multiday running events. In my last work experience in Iceland, I was impressed by how many runners needed physical therapy management and post-race recommendations for a variety of true clinical diagnoses including sciatica, metatarsalgia, posterior tibialis tendonitis, and piriformis syndrome. This reconfirmed to me that the off-road niche is indeed an appropriate place for a physical therapist to offer clinical expertise and knowledge.

In local settings, I have heard private-pay clients state that they would prefer to work with a physical therapist for recurring care instead of using insurance or working with a personal trainer because of the complexity of their medical situation their medical complexity and need for focused multisystem care. This level of expertise is similar to when a client lacks a patellar tendon or undergoes a tracheotomy and needs to be working with a practitioner who has a higher level of medical background and biomechanical analysis.

Innovation, at its heart, is true leadership. It is being at the helm, steering a ship into unknown waters, embracing unexpected adversity and change today for a better tomorrow. Most physical therapists are in the profession because they have passion for movement, connect well with people, and truly care about making a difference. In the current unstable health care climate, we have an excellent opportunity to act as great leaders, driving change through systematic innovation. As exemplified by systematic innovators such as Thomas Edison and Steve Jobs, great leaders implement change by clearly defining problems, identifying the highest priority issues, and assessing what is known and what needs to be discovered in order to render change.

Susan Nowell, PT, DPT, is a PPS member and founder of Endurellect Physical Therapy. She can be reached at sunowell@gmail.com.

Perseverance

It can save your practice—and at the very least, your sanity.

By Mike Cibulka, PT, DPT, MHS, FAPTA, OCS

My first job was at a geriatric hospital. I quickly realized that the physical therapy department had a few professional problems. The first one I noted was the poor caregiving by one particular therapist who had been practicing for about 10 years. Regardless of the patient’s diagnosis, she always had the exact same treatment plan. Patients would sit in a wheelchair “lineup” against the hallway and our physical therapy technician would have them do two sets of 10 military presses with either a one- or two-pound dumbbell. Then after that the physical therapist would put a gait belt on them and have them walk down the hall 10 feet not once but twice, never more, never less. This was the extent of the physical therapy program, every day the same program.

When I first came on board I did not really think anything of this, I just figured that was all of the therapy these people needed given their impairments. But it became “like déjà vu all over again” (borrowing a famous Yogi Berra quote) for each patient. Over time I realized that this was neither appropriate nor ethical, and in fact it was fraud. I discussed my concerns with the physical therapy director who told me that it was none of my business since I was not the director. I soon grew tired of watching this pretense; before long I got out of there and moved on to a new job.

I was hired by a local hospital that was supposed to be one of the most progressive orthopedic physical therapy programs in the area. I had worked there for about 10 months when one day I was given a challenging new patient. The patient was a 48-year-old female who was referred to me for low back pain and sciatica. The “prescription” called for moist heat, ultrasound, and pelvic traction, the usual standing orders for this particular orthopedic surgeon. The patient gave a history citing a laminectomy six months prior, as well as a recent onset of pain down the right leg, from her thigh to foot. On examination she could forward bend, backward bend, and side bend fully without complaint of any back or leg pain. Both the straight leg raise test and crossed straight leg raising test were negative for reproduction of any kind of back or leg pain. Neurologically she had no weakness in either lower extremity, no sign of sacroiliac joint dysfunction, or pain with lumbar spring testing. In fact there was really nothing that should have warranted a diagnosis of sciatica.

The physician’s orders sounded both safe and explicit: The patient just had an aggravation of her sciatic nerve, I should treat it as such. I found this odd because this did not appear consistent with her pain-free and full trunk range of motion (ROM), a negative neurological exam, and unremarkable special test findings. As I hooked her up to traction one day, I again asked about the nature of her pain and was told the pain mainly came on after walking a specific distance. This was starting to sound less and less like sciatica. I checked her lower extremity pulses and noted with surprise that both the right posterior tibialis pulse and right dorsalis pedis pulse were nearly absent when compared to the opposite side. Something was seriously wrong here and a strong surge of adrenaline kept pushing me to think “I may have found her problem.”

I found the referring surgeon and told him about my promising discovery. What I got back was even more astonishing: “When did you get your medical degree?” I was taken aback at first; I told him that I did not have a medical degree but was well trained as a musculoskeletal physical therapist. I was berated with expletives and was told to “back off” (in so many words). My only thought was how could defensiveness play such a strong role in allowing a health care professional to interfere with the clinical decision making for a patient.

I did not lose hope, however. I went to my physical therapy director and told my patient’s story, and the response was eerily similar: “He is the doctor, do what he says to do.” So now I felt stuck between a rock and a hard place. I went back to treating her, without success, and unsurprisingly by the sixth visit her leg pain worsened. I knew I had to do something for this patient. I did what made the most sense; I approached the patient’s family physician and told him what I found. He listened and he followed up with her. Later that day I found out she had received an arteriogram followed by emergency surgery for a condition called “Leriche’s” syndrome, a stenosis of the right internal iliac artery (I had to look that up.) Once again, I felt like I was making a difference in this world. Little did I know what was to come! The next day, I was brought into the physical therapy director’s office and blindsided by the guest appearance of the orthopedic surgeon. In short, I was subsequently fired for insubordination of this particular case. How could that happen? I thought that I helped save this patient from a potential life-threatening condition.

This was one of the most difficult times in my professional career, but it made me a much stronger physical therapist; it gave me the desire to persevere and to believe in myself. It is important to be persistent when your heart tells you that you are right. A few years later while working on my master’s degree at Washington University in St. Louis, I was in Dr. Steven Rose’s office. He was a great mentor, friend, and legend in my eyes. On his wall was a quote written by U.S. President Calvin Coolidge that I will never forget. It read:

“Nothing in the world can take the place of persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent.”

As a practice owner for the past 35 years and manager of several employees, I still occasionally recall this story. I look at the current trends in interprofessional collaboration and how far we have come, not only in our profession but also within the health care community as a whole. If you are in a situation like the one I was in, do not let it get you down, and more importantly, do not go along with the masses. Trust your instincts, trust your heart, and provide quality care for your patients because they have placed their trust in you.

Mike Cibulka, PT, DPT, MHS, FAPTA, OCS, is an associate professor in the physical therapy program at Maryville University in St. Louis, Missouri. Mike also is the founder and owner of Jefferson County Rehabilitation and Sports Clinic. He can be reached at mtcibulka@gmail.com.

Vinitial

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Communicate how patients want to communicate.

By TJ Janicky, PT, DPT

Technology is progressing, whether we are paying attention or not. The pace of technological acceleration is described by Moore’s Law, which states that overall processing power for computers will double every two years. I recently learned that Moore’s Law has held true, and it is no surprise that “most of us are grossly underestimating how large this culture shift is,” as described by Gary Vaynerchuk, entrepreneur, author, and speaker. Vaynerchuk was the keynote speaker at this year’s American Physical Therapy Association (APTA’s) Private Practice Section conference in Orlando. He touched on many topics such as social media platforms and content, “your practice should be a media company first,” and that most of us are never more than arm’s length away from our cell phones.

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And since we are never far from our cell phones, one company has developed an easy and secure way to communicate with patients in the style that many prefer—texting. Vinitial is a secure, Health Insurance Portability and Accountability Act (HIPAA)–compliant texting app for patients and providers, with no need for exchanging cell phone numbers.

I recently learned that most work email is not HIPAA complaint and neither is personal cell phone texting. The company was created by physical therapist Dave Kittle, PT, DPT, with a focus in optimizing communication in the outpatient setting. “Many patients have questions or comments between visits that do not require a phone call and typically would not compel the patient to send an email,” Kittle explains. “When patients hear from their therapist or front desk that the practice uses a secure texting app for communication, traditional barriers preventing questions and communication are then minimized.”

Here are some clinical uses/scenarios I came up with:

  • Change in symptoms (increase or decrease)
  • This specific home exercise resulted in . . .
  • My taping application causes itchiness or a rash.
  • I am running late, can I still come in?
  • I tried to jog/run and . . .
  • Since starting therapy, I am feeling . . .

Your front desk can also be involved with administrative questions such as:

  • Can you remind me of my copay or current balance?
  • Can you clarify my benefits?
  • How many authorized visits do I have?
  • Is the office closing early or opening early due to snow?
  • I am in a work meeting unable to call; I will have to cancel today.

Vinitial is an easy iOS and Android app download that is free for patients and staff clinicians. Patients then search their therapist’s name and send him or her a text.

Check out Vinitial, LLC, at www.vinitial.com or join the conversation on Twitter @VinitialApp.

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TJ Janicky is an Impact editorial board member and outpatient physical therapist at Johns Hopkins Hospital in Baltimore, Maryland. TJ can be reached at tjanicky@gmail.com and @TJ_Janicky on Twitter.

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