In our current health care system, there is the belief that insurance is "the only way to go". There is the perception by patients that their care, especially care such as physical therapy, is driven exclusively by their insurance plan, and that using their insurance is, in fact, the most cost-effective way to deal with an injury. Sadly, this is no longer the case.
In the current insurance-based payment model, your insurance company will "approve" payment for a certain number of physical therapy visits for your current episode of care (and oftentimes over a calendar year). This is typically anywhere from 8 to 12 physical therapy visits. This is what CAN be utilized, not what MUST be utilized.
Physical therapists that are part of these insurance networks are usually reimbursed at a very low rate per patient or per treatment activity. In order to compensate for this, it is then in the best financial interest of the physical therapist to either a) utilize ALL available treatments that have been approved by the insurance company, or b) increase the overall cost to the insurance company in the hope of attaining a greater income based on the percentage paid by the insurance company. The average cost per visit billed by a physical therapist, based on a number of references, is in the range of $100 to $200 per visit.
The patient is typically billed a copay, and many insurance companies are also implementing a specific deductible for physical therapy or allied health services, or a percentage of the bill to be paid by the patient. Patients are now typically faced with $40 copays and up to 20% of the cost of care along with their copay. That can bring the total to well over $60 per patient visit.
More treatment visits do not mean greater improvements in function. Though the national average for back pain is along the lines of 12 visits per episode of care, most practitioners are utilizing non-evidence-based assessment and treatment strategies, and are not focusing on elements of competent self care in conjunction with clinical care provided in order to optimize the patient outcome.
Fortunately, there are some new approaches that return to a focus on quality and value in health care.
It’s beginning to look a lot like Christmas in Bevo World. Ho ho ho, Longhorn football faithful. Imagine this – there are a few coaches that won’t be joining us for the holiday season this year. Offensive coordinator Greg Davis, oft-noted on these pages (and typically for all the wrong reasons) announced his resignation on Monday. Along with this stunning development, offensive line coach Mac McWhorter and defensive line coach Mike Tolleson are retiring. Maybe, just maybe, this is the sign of an upcoming joyous post-bowl game period. The Longhorns may not be going bowling this year, but if this season is what was required to incite change, then so be it. I’ll gladly sacrifice a season for it. At least we beat Nebraska this year. Enough said on that one.
Of course, the news brought talk of all the accolades these coaches have received while on the Forty Acres. We were reminded of how Davis has “mentored” three NFL quarterbacks from the UT roster – Vince Young, Chris Simms, and Colt McCoy. Suffice it to say that at least two of these players (you make the selection) were going to find a way to win regardless of the game plan. I would have you think back to Young’s stunning 4th-and-eternity scramble against Kansas, or his National Championship “Reggie Who?” all-world performance. Not that I am debating the offensive statistics that have been garnered over the years – but when you have talent like that, it’s tough to look bad.
Speaking of talent, the offensive and defensive lines have plenty of talent recruited from the state of Texas. How we were unable to take advantage of this in 2010, I will never understand.
But the bigger story is that Mack Brown finally parted ways with Greg Davis. Perhaps it required an Act of Congress, or a special stealth legislative session in the Texas House, but either way, we’re moving forward from what was a dismal offensive display this year, and a very predictable display in years past. So now, Longhorn faithful, we’re left to ponder who should become the next offensive coordinator. Maybe Opie? Or how about the Pirate?
I can’t say that I was ever terribly excited about the creation of the Big 12 conference in the first place. Take the Big 8 – Kansas, Kansas State, Iowa State, Colorado, Nebraska, Oklahoma, Oklahoma State, and Missouri – and add in Texas, Texas A&M, Baylor, and Texas Tech (from the Southwest Conference), and voila you have the Big 12 conference. I had never really been a fan of Big 8 football. Nebraska used to bore me to tears. Oklahoma was about the same, though at least they had the Red River Rivalry with the University of Texas. Though the conference was created on February 25, 1994, conference play would start on August 31, 1996. The Big 12 has produced some great football and basketball programs. The Big 12 football championship has been won by Oklahoma 7 times, Texas 3 times, and Nebraska twice (Texas A&M, Colorado, and Kansas State have all won it once). I think it is pretty safe to say that over that time period, it became readily apparent that the conference just wasn’t big enough for Texas and Nebraska. The Cornhuskers have always been owned by the Horns in football (much to their chagrin), and were certainly no longer the “high profile program” that they may have once been in the Big 8.
So with that in mind, Nebraska moved to the Big 10 conference. They claim that it was a better fit academically, but I suspect that Athletic Director Tom Osborne no longer wanted to play second fiddle to Texas in terms of conference television revenues, among other things. Call that just an educated guess on my part.
The Huskers went into Big 12 play this season with hopes of making a parting shot at the conference, while looking forward to the promised land of 2011 in the Big 10. But it’s not been a bed of roses for the Children of the Corn.
I’ve noticed over the years that it can become far too easy to get caught up in the distractions of daily life. It then becomes pretty easy to gradually lose sight of what is truly important in life, the passions that make us smile, the people that are truly deserving of our time and attention. And it is far too easy to let yourself become cynical about the world, or to become jaded, or to just take a more passive approach to life in general. There are moments when I am sure all of us have done this. For many, it is hopefully short-lived. For others, it might require a death in the family or a significant life trauma, something that wakes us up to make us smell the proverbial coffee. It could be something that forces us to re-prioritize and re-focus our efforts on those things which truly make our heart sing and give our world wings with which to soar above the distractions.
Which brings me back to music. Again.
What a difference ten months can make.It seems like just yesterday (make that January) that the University of Texas Longhorns were in the 2010 BCS National Championship game. Longhorn fans watched in virtual horror as Colt McCoy left the field with an injury. Those same fans watched with great excitement as Austin’s very own Garrett Gilbert, a freshman, put the Horns back in contention with a tremendous second half performance. Gilbert almost pulled off the impossible as a freshman in what truly amounted to his first significant playing time all year. What a way to start your college football career.
Now, it is ten months later. The fans are now officially out of their misery, with the season ending with a record of 5 – 7 and no bowl in our future. There have been very few teams in college football history that have plummeted this far, this fast, after a national championship appearance. And, lest any Longhorns fans need reminding, it’s the first losing season in Mack Brown’s tenure, and the first losing season since, yes, John Mackovic’s final season in 1997. If the thought of that doesn’t make you squirm, I am not sure what would.
For those who missed it, we managed to beat Nebraska this year, sending them to the Big 10 with a farewell that UT faithful truly enjoyed. That was on October 16. From there, it was all downhill. Losses to Iowa State – the first time ever – and Baylor – the first time in almost forever – followed. There was a loss on the road at Kansas State. Better yet, call that a drubbing. Let us not forget the loss at home to Oklahoma State – another first – and follow that up with a loss to Texas A&M, again at home. October 16 was truly a long time ago in a football galaxy far, far away.
So with the demise upon us, where does Mack Brown start to find the answers?
Thanksgiving - a word that evokes many responses from many people.For some, it is just another day. For others, it conjures up images of turkey and stuffing and pumpkin pie. It is a time to get together with family and friends. It is a time to give thanks for a bountiful harvest.
And for some, it may even be symbolic of the start of the holiday season, or the coming of Hanukkah, or the impending economic surge of the biggest shopping day in the nation, Black Friday.
Whatever you call it, and whatever meaning you place on it, today is Thanksgiving Day in the United States, a day of festive family traditions. On this day, people give thanks for a plethora of things. And I am no different in this regard.
It can be pretty easy to forget about, or just overlook, all those things that make our world brighter and more vibrant on a daily or moment-to-moment basis. And we all know that it has become far easier to find fault and lay blame than to simply tell someone that they have done a good job or that they bring something special to our world.
I think it is far more important to acknowledge the greatness in our world. If we all did this, I think the world would be a better place to live. I truly believe in being thankful for and appreciate the simple things in life that make our lives more vivid and much more passionate and loving.
So for Thanksgiving 2010, I present to you a list of things for which I am thankful:
Latest update: November 17, 2010 (see below) - The Eagle Has Landed!! Monday November 1 marked the beginning of National Novel Writing Month – otherwise known as “NaNoWriMo”. The goal of NaNoWriMo is simple – shut up and write! Actually, the stated goals are to write a novel of 50,000 words of fiction over the month of November. That amounts to approximately 175 pages of writing. At the end of the month, you have your word count and text validated, and if you make that 50,000 word threshold, you are officially classified as a “winner”.
No, that doesn’t mean that your book will automatically be published, or that Steven Spielberg will want to direct a big screen version of it (though I do think that Matt Damon could play the lead in my story, but more about that later). Or that it will even be decent writing at all, or that anyone other than yourself, friends, and family will even care. And there aren’t any big prizes other than the pride in knowing that you did it.
This year is the 12th year that NaNoWriMo has been in existence. It started with 21 participants in 1999. In 2009, there were 165,000+ participants, and 30,000+ of them completed the challenge. They have also created a Young Writers Program.
I am not sure I had ever really considered writing a novel. I definitely hadn’t ever thought of it in high school. But then, the inspiration suddenly hit me. It wasn’t about writing a novel. It was about becoming a better writer – regardless of the genre, fiction or non-fiction.
And, imagine this, it was about the mental challenge – not that I have ever undertaken a task for that reason. That’s my story, and I am sticking with it.
Up to 60% of runners will sustain an injury within any given year. Poor running mechanics, in conjunction with poor, ineffective and outdated training methods, can pose a significant injury risk. "RunSmart" was written to address these issues in the running community.
"Running Injuries: Etiology And Recovery- Based Treatment" (co-author Bridget Clark, PT) appears in the third edition and fourth editions of "Clinical Orthopaedic Rehabilitation: A Team Approach" by Charles Giangarra, MD and Robert C. Manske, PT.
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.
Top 5 finalist in three categories: "Best Overall Blog", "Best PT Blog" and "Best Advocacy Blog".
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