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ADVANCE Perspective: Physical Therapy & Rehab Medicine

CSM 2012: Get Ready

Published February 10, 2012 11:29 AM by Lisa Lombardo

CHICAGO -- To quote Peter J. McMenamin, PT, MS, OCS, whether you love or hate the Health Care Affordability Act, "health services changes aren't going to go away."

McMenamin opened the session ‘Physical Therapists Impacting health Policy Through Health Services Research: A Survival Strategy for Health Care Reform, Part I" on Feb. 9 at the APTA Combined Sections Meeting.

Therapists need to recognize the importance of participating in health services research. The debate over changing health care policy is decided; now, the PT profession has to prove their worth in health services reimbursement and decisions on care delivery.

"PT has always been involved in health care research; we sent reconstruction aides to Europe, where Britain used rehab services to improve outcomes for soldiers, and this evolved into the PT profession," he said.

The questions for the profession are, can PT be more efficient, effective and equitable? "We can't be wasting time with less effective treatments," he said. The profession will be undertaking more systemic reviews and random controlled trials in research. Efficiency in practice is just as important. McMenamin noted that the U.S. spends $8,000 per person for health care, but still ranks 65th out of 100, with 48 million still uninsured. "Ask, do we get enough bang for our buck for $8,000?" he said

Research involves economics, there is no escaping it," he said. "It becomes a consumer issue: Can people afford care? And can businesses afford premiums? And of course it is becoming a huge political issue as well," McMenamin said.

The moment has arrived for the PT profession to act, or be pushed to the margins of health policy decisions on how consumers can both select and pay for quality health care. "Our role is to make our services more accessible to consumers," he said.

PTs in Health Services Research

Janet Freburger, PT, PhD, who is a researcher with the Cecil G. Sheps Center for Health Services Research, said within the last decade, the PT profession has grown in providing broader research for journals, which increases the visibility of the PT to address many problems facing the health care system in the U.S.

She noted that a lack of evidence on treatment can lead to overuse, underuse and misuse of care. "We have to provide services based on scientific knowledge and avoid those services not likely to benefit the patient," she said. There is a lot of practice variation within the scope of PT treatments, often because there is a lack of evidence to support many treatments, as well as a lag between discovery and implementation of new treatments that could be effective.

Sometimes higher spending [on treatments] doesn't relate to better outcomes, and that is why the profession needs to be at the forefront of health services research, to concentrate on the treatments that are both effective and efficient and have the data to back them up.

She said PT seems to take the lead in equitable care. In outpatient care provision, there are some disparities in areas of research, but overall there is little evidence of racial or ethnic disparity for PT, "which shows we aim to understand different populations" in providing care.

She discussed studies of efficiency in PT care delivery, and noted that the profession has proved that earlier PT care does benefit most patients overall, and that other studies have shown that direct access for PT does lead to better outcomes, as well as being more efficient in some cases, relieving physicians from duties prescribing PT. Both research-based arguments benefit the PT profession.

"We need to understand what works best, and have to get patients more involved in choosing their own care," she said. Opportunities for more research are built into the Affordable Care Act, she noted, and the focus is on comparative clinical research. "We need more studies to help decrease any disparities in care delivery," Dr. Freburger noted.

The health policy subject was a popular one at the conference; look for follow-ups on this blog for Part 2 on the initiatives APTA is taking to improve its position in health policy decision-making.

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