Health care is in dire need of transformation. The system as we know it has been built on a foundation of principles that have conflicting values. Whether it’s the reimbursement models or the practice patterns, or both, the concepts of “quality” and “value” have been lost in the mix. What has become the accepted standard of care and delivery has become outdated, and in the midst of it, the patient – the driver of all of this – has been forgotten.

In any other realm, we look to quality and value as two key elements of an exceptional customer experience. A free and open marketplace fosters this. Consumers critically examine cost, quality of service, and results in their decision-making process for just about everything – cars, homes, education, you name it. Except health care.

Patients have learned to accept the gross failures and inadequacies of the health care system. Are patients satisfied with their care? Sure. But are their expectations of this “accepted standard” really at a high enough level? Or are they satisfied with something less simply because they have been told that that is the accepted standard?

This becomes all the more apparent in the world of physical therapy. When there are clinicians proclaiming that “first class service and results” create “the top physical therapy clinic for patient satisfaction” – and then stating that the “average length of stay is 10 visits – guaranteed” – I shake my head in disbelief. When 10 visits per course of care is considered “great care”, I have to wonder about what has become the accepted standard these days.

And there is plenty of finger-pointing by the clinicians at the insurance companies. It’s their fault for such low reimbursement rates, right? On the surface, there are many instances in which the finger-pointing may be well-deserved. But when you point a finger, as they say, four point back at you. The clinicians are as much to blame as anyone, and much of that has to do with a simple lack of innovation at a far deeper, systemic level. It starts with the clinician, their product, and their means of delivery.

Transformation requires a deeper level of understanding of the systemic problems, so let’s start there first.

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Yes, a win is a win is a win. But this win was ugly.

One week ago I was raving at having witnessed the best 30 minutes of football I'd seen by anyone all year. Today, I experienced what was the worst 30 minutes of football I'd seen by the Longhorns all season. Actually, we might want to stretch that number out to about 45 minutes, if you take into account all of the minutes that the defense stunk up the joint.

The sign of a championship team is their ability to come through in the crunch, to fight through adversity, to win games when they just can't seem to get it together. If that is the case, then the Longhorns are truly championship material. As long as today is the low point of the season - at least for the defense.

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Direct access to Physical Therapy still faces many barriers in the United States. Many of these barriers are simply not in the best interest of the patient, in that the current regulatory practice of a "referral" process to get to the appropriate provider creates greater costs for the patient and the right to immediate and effective care, a fact that patients simply do not understand.

As a physical therapist in Texas, I have watched the continued struggle with direct access to Physical Therapy. Texans can see a Physical Therapist for an initial evaluation, but cannot subsequently receive treatment without a physician referral. As a McKenzie practitioner, not having direct access is an enormous barrier to caring for our patients. With an assessment process that naturally shifts to treatment, we are faced with a dilemma. If the assessment reveals a directional preference, then instead of simply taking the next step and educating the patient regarding the importance of this, we must then interject "you need to see a physician for a referral."

In an era of “evidence”, there is plenty to indicate that direct access to Physical Therapy would increase a patient’s access to appropriate and necessary health care, decrease their cost of care and restore the patient’s right to choose.

In order for our health care system to move forward, it is time for all of us to put our best foot forward and foster a medical system that is truly patient-centered.

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In the name of the founding fathers - let the damn people vote!

Over the past two elections, we've been exposed to some questionable voting practices. We've seen hanging chads and problems with electronic voting stations. In the past few DAYS of early voting, we've already been exposed to what I would call "extremists" that are trying to influence the voting process by giving people bad information. In Austin, there have been reports of people instructing others in improper voting practices so that they effectively spoil their vote. And that is but one example that we have seen locally, let alone nationally. This type of thing has the potential to make a shambles of our voting system.

And therein lies one of the greatest threats to this great country in which we live - it's the enemy within.

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