Pow Þhvslcal 1heraplsLs Can

1hrlve under PealLh Care 8eform
AuausL 20Ŵ21ţ 2011
Crlandoţ llorlda
1lm 8lchardsonţ Þ1
1lm8lchÞ1«8ulleLproofÞ1Ŧcom
1he llorlda Þhvslcal 1heraplsLs ln ÞrlvaLe ÞracLlce (lLÞ1ÞÞ) presenLs
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1he llorlda Þhvslcal 1heraplsLs ln ÞrlvaLe ÞracLlce (lLÞ1ÞÞ) presenLs
Armln Loaesţ Þ1
Chrls Mulvevţ Þ1
1lm 8lchardsonţ Þ1
ulane ParLelvţ Þ1
Lrlc uoualassţ Þ1
8oberL uraaanţ Þ1
SLephen 1rlnqueţ Þ1
1om Zellerţ Þ1
1rlcla 1rlnqueţ Þ1
Can We uo 8eLLer?
· 47 mllllon unlnsured AmerlcansŦ
· Amerlca spends more Lhan anv oLher counLrv ln Lhe
worldsţ almosL 17Ʒ of Cross uomesLlc ÞroducL (CuÞ)ţ on
healLhcareŦ
· 8uLţ Amerlca ranks #37 ln CuallLv and lalrness accordlna
Lo Lhe World PealLh CraanlzaLlon (WPC)Ŧ
Cllck Lhe llnk for Lhe 2008 Þ8S lronLllne documenLarv 5lck
AtoooJ 1be wotlJŦ
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Can We uo 8eLLer?
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Can We uo 8eLLer?
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Can We uo 8eLLer?
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WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
1he Shared Savlnas Þroaram ls deslaned Lo lmprove beneflclarv ouLcomes and
lncrease value of care bvť
· ÞromoLlna accounLablllLv for Lhe care of |nd|v|dua| Medlcare feeŴforŴ
servlce beneflclarlesŦ
· 8equlrlna coordlnaLed care for all servlces provlded to a popu|at|on of
peop|e under Medlcare leeŴlorŴServlceŦ
· Lncouraalna lnvesLmenL ln lnfrasLrucLure and redeslaned care processes
|n order to reduce the perŴcap|ta cost of hea|thcareŦ
Lllalble provldersţ hosplLals and suppllers mav parLlclpaLe ln Lhe Shared Savlnas
Þroaram bv creaLlna or [olnlna an AccounLable Care CraanlzaLlonţ also called an
ACCŦ 1he ACC ls expecLed Lo LranslLlon Lo populaLlonŴbased pavmenL
arranaemenLs
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WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
SecLlon 3022 of Lhe Affordable Care AcL LhaL was slaned lnLo law bv ÞresldenL 8arack
Cbama on March 23ţ 2010 requlres Lhe CenLers for Medlcare and Medlcald Servlces
(CMS) Lo esLabllsh a Shared Savlnas Þroaram Lo faclllLaLe coordlnaLlon and
cooperaLlon amona provlders Lo lmprove Lhe quallLv of care for Medlcare feeŴforŴ
servlce beneflclarles and reduce unnecessarv cosLsŦ
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ACC CuallLv Measures
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ACC CuallLv Measures
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ACC CuallLv Measures
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ACC CuallLv Measures
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ACC CuallLv Measures
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ACC CuallLv Measures
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ACC CuallLv Measures
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ACC CuallLv Measures
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CMS ls proposlna Lo deflne Lhe flrsL quallLv performance perlod as bealnnlna !anuarv
1ţ 2012ţ and endlna uecember 31ţ 2012Ŧ
lor Lhe flrsL vear of Lhe Shared Savlnas Þroaramţ CMS proposes Lo seL Lhe quallLv
performance sLandard f be tepotloo levelŦ
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WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
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1he Þhvslclan Croup ÞracLlce (ÞCÞ) uemonsLraLlon was Lhe flrsL pavŴforŴ
performance lnlLlaLlve for phvslclans under Lhe Medlcare proaramŦ
1Ŧ 8llllnas Cllnlcţ 8llllnasţ MonLana
2Ŧ uarLmouLhŴPlLchcock Cllnlcţ 8edfordţ new Pampshlre
3Ŧ 1he LvereLL Cllnlcţ LvereLLţ WashlnaLon
4Ŧ lorsvLh Medlcal Croupţ WlnsLonŴSalemţ norLh Carollna
3Ŧ Celslnaer PealLh SvsLemţ uanvllleţ Þennsvlvanla
6Ŧ Marshfleld Cllnlcţ Marshfleldţ Wlsconsln
7Ŧ Mlddlesex PealLh SvsLemţ MlddleLownţ ConnecLlcuL
8Ŧ Þark nlcolleL PealLh Servlcesţ SLŦ Louls Þarkţ MlnnesoLa
9Ŧ SLŦ !ohn's PealLh SvsLemţ Sprlnafleldţ Mlssourl
10Ŧ unlverslLv of Mlchlaan laculLv Croup ÞracLlceţ Ann Arborţ Mlchlaan
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WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
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1here are Lhree prlmarv wavs for an ACC Lo achleve
savlnas on Lhe care of Lhe asslaned Medlcare populaLlonť
1Ŧ 8educlna emeraencv room vlslLs and hosplLal lnpaLlenL
admlsslonsŦ
2Ŧ 8educlna Lhe provlslon of speclalLv care for Lhe
asslaned Medlcare paLlenL populaLlon
3Ŧ 8educlna Lhe provlslon of lmaalna and oLher speclal
LesLs
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WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
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9revent|ng Avo|dab|e nosp|ta| keŴadm|ss|ons
ÞrevenLable readmlsslons can occur because
ofŦŦŦ
· nadequaLe dlscharae plannlna
· nadequaLe posLŴdlscharae followŴup
· Lack of coordlnaLlon beLween lnpaLlenL and
ouLpaLlenL healLhcare LeamsŦ
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WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
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SmlLh eL al reporLed on Lhe dlscharae recommendaLlons of 40 phvslcal
LheraplsLs LreaLlna 762 paLlenLs aL a laraeţ acuLe care hosplLalŦ SmlLh
wanLed Lo see how ofLen Lhe LheraplsLs' recommendaLlons were followedŦ
1he LheraplsLs' dlscharae recommendaLlons were followed 83Ʒ of Lhe LlmeŦ
1here was a mlsmaLch ln Þ1 recommendaLlon and paLlenL dlscharae
locaLlon ln 124 of 743 cases Ŧ
When Lhe LheraplsLs' recommendaLlons were nC1 followedţ Lhe paLlenLs
were 2Ŧ9 Llmes MC8L llkelv Lo be readmlLLed Lhan when Lhe
recommendaLlons were followedŦ
1he hosplLal had an 18Ʒ 30Ŵdav reŴadmlsslon raLeţ whlch ls conslsLenL wlLh
Lhe llLeraLureŦ
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WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
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pec|a||st Costs
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WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
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CveruLlllzaLlon of CA1 scansť
uouble bllllna Lhe Medlcare proaram
mag|ng Costs
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ntervent|on ke|mbursement kange of Lst|mated Charges
Lumbar splne radloaraphv $30
$204Ŷ286 (ln neLwork)
$404Ŷ363 (ouL of neLwork)
Lumbar splne compuLed
Lomoaraphv
$381 (wlLhouL conLrasL)
$439 (wlLh conLrasL)
$1082Ŷ1317 (ln neLwork)
$2091Ŷ2928 (ouL of neLwork)
Lumbar splne maaneLlc
resonance lmaalna
$713 (wlLhouL conLrasL)
$863 (wlLh conLrasL)
$877Ŷ1226 (ln neLwork)
$1762Ŷ2467 (ouL of neLwork)
WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
mag|ng Costs
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WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
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WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
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WhaL ls an AccounLable Care
CraanlzaLlon (ACC)?
8lsk Ǝ 8eward
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
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9opu|at|on hea|th has been deflned as #be beflb oocomes of f otoop of loJlvlJoflsţ
locloJloo be Jlstlboloo of socb oocomes wlblo be otoopŦ´
L ls an approach Lo healLh LhaL alms Lo lmprove Lhe healLh of an enLlre populaLlonŦ
Cne ma[or sLep ln achlevlna Lhls alm ls Lo reduce healLh lnequlLles amona populaLlon aroupsŦ
ÞopulaLlon healLh seeks Lo sLep bevond Lhe lndlvldualŴlevel focus of
malnsLream medlclne and publlc healLh bv addresslna a broad ranae of facLors LhaL lmpacL
healLh on a populaLlonŴlevelţ such as envlronmenLţ soclal sLrucLureţ resource dlsLrlbuLlonţ
eLcŦ
An lmporLanL Lheme ln populaLlon healLh ls lmporLance of soclal deLermlnanLs of healLh and
Lhe relaLlvelv mlnor lmpacL LhaL medlclne and healLhcare have on lmprovlna healLh overallŦ
lrom a populaLlon healLh perspecLlveţ healLh has been deflned noL slmplv as a sLaLe free
from dlsease buL as ƍbe cfpfcl of people o fJfp oţ tespooJ oţ ot cootol llfeƌs
cbflleooes foJ cbfooesºŦ
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
|agnos|s
1he process Lhe cllnlclan uses Lo move proaresslvelv from a realon
of low cllnlcal cerLalnLv Lo a realon of hlah cllnlcal cerLalnLvŦ
n low probablllLv condlLlonsţ screenlna LesLs are used Lo aeneraLe
dlaanosLlc posslblllLles and Lo ºrule ouL" lmprobable condlLlonsŦ
n hlah probablllLv condlLlonsţ dlaanosLlc LesLs are used Lo conflrmţ
or ºrule ln" llkelv condlLlonsŦ
8oLh LesLlna and LreaLmenL carrv rlskŦ
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
now Are 9hys|ca| 1herap|sts Mak|ng |agnoses?
· SelfŴ8aLed and Þhvslcal CharacLerlsLlcs
· 1reaLmenL 8ased ClasslflcaLlon
· ÞaLholoalcal CondlLlons
· ÞsvchoŴSoclal CondlLlons
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
e|f kated and 9hys|ca| Character|st|cs 9reva|ence
ºlalr" or ºÞoor" selfŴraLed healLh 44Ʒ
Chronlc uepresslon ln AdulLs 6Ŧ7Ʒ
Cenerallzed AnxleLv ln AdulLs 18Ŧ1Ʒ
usual CalL Speed Ƽ 0Ŧ42m/s 23Ʒ
8apld CalL Speed Ƽ 0Ŧ37m/s 23Ʒ
1hree Chalr SquaLs ƽ 10secŦ 24Ʒ
Anv alcohol use 62Ʒ
ƽ 3 medlcaLlons 33Ʒ
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
· Cu
· SÞAu
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
1reatment 8ased C|ass|f|cat|on 9reva|ence
ManlpulaLlon for L8Þ Croup 33 Ŵ 43Ʒ
SLablllzaLlon for L8Þ Croup 8 Ŵ 72Ʒ
Lumbar 1racLlon for L8Þ Croup 9 Ŵ 24Ʒ
ulrecLlonal Þreference for L8Þ Croup 18 Ŵ 43Ʒ
1horaclc ManlpulaLlon for neck Þaln 34Ʒ
1horaclc ManlpulaLlon for Arm Þaln 61Ʒ
MoblllzaLlon for LaLeral Ankle Spraln 73Ʒ
Plp !olnL MoblllzaLlon for AnLerlor knee Þaln 68Ʒ
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
9atho|ogy 9reva|ence
Ankle lracLure followlna 1rauma 13Ʒ
knee lracLure followlna 1rauma 6Ʒ
ueep veln 1hrombosls ln posLŴsuralcal paLlenLs varles
Carpal 1unnel Svndrome ln paLlenL wlLh wrlsL paln/numbness 34Ʒ
Splnal lracLure followlna 1rauma ln Clder Þeople 0Ŧ3 Ŵ 3Ŧ0Ʒ
CommunlLv Acqulred Þneumonla (CAÞ) 2 Ŵ 8Ʒ
AcuLe SLroke ln ulzzv ÞaLlenLs ln Lhe Lmeraencv SeLLlna 23Ʒ
Plp !olnL MoblllzaLlon for AnLerlor knee Þaln 68Ʒ
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
9red|ct|on of Commun|ty Acqu|red 9neumon|a (CA9%
· 1emperaLure ƽ 100Ŧ04
o
· Þulse ƽ 100bpm
· Crackles/8ales on ausculLaLlon
· uecreased breaLh sounds on ausculLaLlon
· no asLhma
1he cllnlclan asslans one polnL for each of Lhe flndlnas
LhaL ls pteseoŦ
C||n|ca| ec|s|on ku|es
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
9red|ct|on of Commun|ty Acqu|red 9neumon|a (CA9%
Þrevalence of Þneumonla ln Þrlmarv Care ƹ 2Ʒ
C||n|ca| ec|s|on ku|es
now many var|ab|es are present?
0 presenL 2Ʒ llkelv
1 presenL 3Ʒ llkelv
2 presenL 11Ʒ llkelv
3 presenL 22Ʒ llkelv
4 presenL 33Ʒ llkelv
3 presenL 73Ʒ llkelv
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
9red|ct|on of Commun|ty Acqu|red 9neumon|a (CA9%
Þrevalence of Þneumonla ln Lhe Lmeraencv seLLlna ƹ 8Ʒ
C||n|ca| ec|s|on ku|es
now many var|ab|es are present?
0Ŵ1 presenL 8Ʒ llkelv
2Ŵ3 presenL 27Ʒ llkelv
4 presenL 69Ʒ llkelv
3 presenL 100Ʒ llkelv
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
9red|ct|on of Commun|ty Acqu|red 9neumon|a (CA9%
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
Luna Soundsť normal
Luna Soundsť Crackles/8ales
Luna Soundsť Wheezlna
9red|ct|on of Commun|ty Acqu|red 9neumon|a (CA9%
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
nd|v|dua| I|nd|ngs 9os|t|ve L|ke||hood
kat|o (+Lk%
-egat|ve L|ke||hood
kat|o (ŴLk%
uecreased 8reaLh Sounds 3Ŧ7 0Ŧ7
Wheezlna 3Ŧ8 0Ŧ66
8honchl 3Ŧ9 0Ŧ93
9red|ct|on of Commun|ty Acqu|red 9neumon|a (CA9%
9neumon|a ec|s|on ku|e 9os|t|ve L|ke||hood
kat|o (+Lk%
-egat|ve L|ke||hood
kat|o (ŴLk%
0 or 1 flndlnas Ŵ 0Ŧ3
2 or 3 flndlnas Ŵ Ŵ
4 or 3 flndlnas 8Ŧ2 Ŵ
ŦŦŦcompared wlLhŦŦŦ
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
uerlve Snţ Spţ +L8ţ ŴL8 wlLh a 2x2 Lable
need Þneumonla numbers
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Pow Lo Manaae a ÞaLlenL ÞopulaLlon
McGee's 8eds|de Lst|mates
L|ke||hood kat|o Lst|mated 9robab|||ty h|ft
0Ŧ1 Ŵ 43Ʒ
0Ŧ2 Ŵ 30Ʒ
0Ŧ3 Ŵ 23Ʒ
0Ŧ4 Ŵ 20Ʒ
0Ŧ3 Ŵ 13Ʒ
1 no chanae
2 +13Ʒ
3 +20Ʒ
4 +23Ʒ
3 +30Ʒ
6 +33Ʒ
7
8 +40Ʒ
9
10 + 43Ʒ
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Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
· Lxerclse ls aenerallv nC1 harmfulŦ Þower LralnlnaŦ
· ncreasedţ selfŴdlrecLed acLlvlLv ls essenLlal Lo
reduclna dlsablllLvŦ
· ÞromoLe acLlvlLvť walklnaţ voaaţ runnlnaţ llfLlnaţ
reslsLance proaramsţ Zumbaţ ÞllaLesţ aardenlnaţ
aolfţ flshlnaŦ
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Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
· PurL ƺ ParmŦ IA8Ŧ 8eference?
· LmoLlonal/MenLal facLors mav drlve 30Ŵ33Ʒ of
musculoskeleLal ouLcomesŦ lear Avoldance
8ehavlorsŦ %lok o lfttfb lfwcee £xetclse bft)Ŧ
· 8ehavloral Lralnlna more lmporLanL Lhan
CoanlLlve Lralnlna
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Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
maae of dlsclalmer
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Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
AdequaLe phvslcal acLlvlLv ls llnked wlLh lmporLanL healLh
ouLcomesŧ
· 8educed cardlovascular dlsease
· 1vpe 2 dlabeLes
· Some cancers
· luLure falls rlsk
· CsLeoporoLlc fracLures
· uepresslon
· Þhvslcal funcLlon scores on sLandardlzed self reporL
measures
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8ehav|or Change Assumpt|ons
LducaLlon
knowledae
8ehavlor Chanae
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
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Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
8ehavloral lnLervenLlons MC8L effecLlve Lhan
educaLlonal lnLervenLlonsŦ
· Coal seLLlna/conLracLlna
· SelfŴmonlLorlna (Þaln scales/luncLlonal Scales Ŷ
ueuscher sLudv)
· leedback
· Consequences/rewards
· Lxerclse prescrlpLlon
· Cues
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Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
Goa|s
÷ uo slnale lea sLandlna x 30secŦ Lhree Llmes per dav
Lo lmprove balanceŦ
Cues
÷ llrsL Lhlna ln Lhe mornlna do slnale lea sLandlna x
30secŦ ln Lhe klLchen whlle Lhe coffee percolaLesŦ
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Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
LducaLlonal/coanlLlve lnLervenLlons LLSS effecLlve aL
promoLlna phvslcal acLlvlLv
· 1araeLlna knowledaeţ aLLlLudes or bellefs
· Mass medla (vsŦ lndlvlduallzed lnsLrucLlon)Ŧ
· 1ralnŴLheŴLralner models (vsŦ sLaff provldlna
lnLervenLlons dlrecLlv Lo paLlenLs)Ŧ
· dlosvncraLlc provlder lnLervenLlons (vsŦ sLandardlzed
recommendaLlons)Ŧ
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Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
#Med|ca| 1heater"
8eal LreaLmenL effecLs/ouLcomes due Lo some
aspecL of Lhe medlcal lnLervenLlon oLher Lhan Lhe
phvsloloalc effecLŦ nC1 a placebo!
#A plfcebo ls f sobsfoce ot
ptoceJoteŧbf ls objeclvel wlboo
speclflc fclvl fot be cooJlloo beloo
tefeJŧ´
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
33
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
Jhat dr|ves outcomes |n add|t|on to the |ntended
treatment?
uressť 1he whlLe coasL and sLeLhoscope
Lanauaaeť Medlcal [araon based ln LaLln
ulaanosls and LxpecLaLlonť 1he effecL on funcLlonal sLaLus
over Llme of a dlaanosls of ºdlsc deaeneraLlon"
CosLť More cosLlv medlcal LreaLmenLs have a hlaher cosL
and a hlaher percelved beneflL
Colorť 8lue plll vsŦ 8ed plll sLudv bv 8lackwell
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
34
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
#Med|ca| 1heater"
· AlbuLerol vsŦ Sham AcupuncLure for AsLhma (2011)
· 8randed Analaeslcs for Peadache (1981)
· 8ed plll vsŦ 8lue Þlll for Mood AlLeraLlon (1972)
· nLernal Mammarv ArLerv LlaaLlon for ChesL Þaln
(1939ţ 1960)
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
33
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
#Med|ca| 1heater"
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
36
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
#Med|ca| 1heater"
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
37
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
#Med|ca| 1heater"
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
38
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
#Med|ca| 1heater"
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
39
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
nea|th Coach|ng
PoLspoLs bv ALul Cawandeţ Mu feaLurlna
!effrev 8rennerţ Mu
new ?orker maaazlne arLlcle
lronLllne ºPoLspoLLers" vldeo
uownloadable sllde show aL
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60
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
1he Slx Sources of nfluence
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
61
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
62
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
Pow Lo Þersuade vour ÞaLlenL
· SLone eL al aLLempLed Lo chanae colleae sLudenL sexual
proLecLlon behavlorŦ
· LecLured Lhe sLudenLsť #Dse cooJoms!´ Ŷ dldn'L work
· Pad colleae sLudenLs make an educaLlonal vldeo Lo Leach hlah
school sLudenLs abouL proLecLed sexŦ
· 1echnlque workedŦ
· 80Ʒ of Lhe colleae sLudenLs bouahL condoms lmmedlaLelv and
Lhe amounL of condoms purchased was areaLer Lhan a conLrol
aroupŦ
· 1echnlque known as CoanlLlve ulssonanceŦ
uownloadable sllde show aL
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63
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
CrlLlcal ÞaLhwavs of Careť
SLarbucks/AeLna Saves Monevţ mproves CuLcomes
uownloadable sllde show aL
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64
Pow Þhvslcal 1heraplsLs Can urlve
8eLLer CuLcomes
CosLs and ÞroducLlvlLv
Metr|c Med|an
Charae per vlslL $164Ŧ26
ÞavmenL per vlslL (SouLh 8ealon) $83Ŧ18
ÞavmenL per vlslL (naLlonal) $94Ŧ77
number of paLlenL vlslLs per hour 2Ŧ86
Þavroll as a percenL of lncome (lncludes Cwner's ºreplacemenL
cosL")
63Ŧ6Ʒ
number of vlslLs per paLlenL (slnale vlslL paLlenLs exLracLed) 11Ŧ6
Cancel/noŴshow raLe 11Ŧ2Ʒ
1lme Lo Cash 40 davs
Þaver Mlxť Medlcare 22Ŧ7Ʒ
ÞroflL Maraln 14Ŧ2Ʒ
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
63
ulsrupLlve nnovaLlon
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
#1be bosloess moJels of beflb fte ftozeo lo be bosplfl foJ be Jocots´ offlceŦ 1be
pfb o flxloo be ssem ls o Jlstop bose moJelsŦ´
ClavLon ChrlsLensen
1he nnovaLor's ÞrescrlpLlon
1here are reallv Lhree buslness model under one roof ln Lhe hosplLalť
1Ŧ Þreclslon medlclne LhaL can be ºkoololzeJ´Ŧ 1he aoal ls Lo ldenLlfv areas where
auLomaLlon of repeLlLlve Lasks can lmprove care and save cosLsŦ Lxampleť 1oLal knee
8eplacemenLsŦ
2Ŧ nLulLlve medlclne LhaL requlres hlahlv Lralned speclallsLs uslna cosLlv dlaanosLlc LesLlna
machlnes Lo dlscover Lhe besL LreaLmenL approachŦ Lxampleť Creaorv Pouseţ MuŦ
3Ŧ Lmplrlcal medlclne ls Lhe cosLlv LrlalŴandŴerror realm of chronlc dlsease manaaemenLŦ
ChrlsLensen predlcLs an lncrease ln paLlenL auLonomvţ selfŴdlaanosls and selfŴcare
cholcesŦ 1he rlse of soclal neLworks wlll feaLure promlnenLlv ln Lhls realmŦ Lxampleť
CuLpaLlenL Þhvslcal 1herapvŦ
66
SLrucLured uaLa
SLrucLured daLa ls anoLher wav of referrlna Lo daLa
LhaL ls enLered lnLo a speclflc fleld as opposed Lo free
LexL ln a charL noLeŦ
60Ʒ of Lhe narraLlve noLe daLa ls losL Lo Lhe LM8Ŧ
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
67
SLrucLured uaLa
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
68
SLrucLured uaLa
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
69
SLrucLured uaLa
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
70
SLrucLured uaLa
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
71
SLrucLured uaLa
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
72
SLrucLured uaLa
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
73
SLrucLured uaLa
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
74
SLrucLured uaLa
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
73
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
76
CACL 8ule for Alcohollsm Screenlna
· An esLlmaLed 100 mllllon Amerlcans drlnk alcoholŦ
· 10Ʒ of Lhose who drlnk have alcohol problems LhaL adverselv affecL Lhelr
llves and Lhelr famllles llvesŦ
· 1he morLallLv raLe of Lhose who drlnk 6 or more drlnks per dav ls 30Ʒ Lhan
maLched conLrolsŦ
· Alcohol ls a ma[or facLor ln sulcldesţ homlcldesţ vlolenL crlmes and moLor
vehlcle accldenLsŦ
· Þhvslclans are abouL Lo recoanlzeţ wlLhouL declslon aldsţ onlv abouL half of
Lhe problem drlnkers Lhev encounLerŦ
· Þhvslclans are even LLSS llkelv Lo ldenLlfvţ wlLhouL declslon aldsţ alcohol
problems ln women and elderlv peopleŦ
ueclslon 8ules
CACL 8ule for Alcohollsm Screenlna
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
77
1Ŧ ºPave vou ever felL vou ouahL Lo cut down on vour drlnklna?"
2Ŧ ºPave people annoyed vou bv crlLlclzlna vour drlnklna?"
3Ŧ ºPave vou ever felL bad or gu||ty abouL vour drlnklna?"
4Ŧ ºPave vou ever had a drlnk (eye opener) flrsL Lhlna ln Lhe mornlna Lo sLeadv vour nerves
or aeL rld of a hanaover?"
ueclslon 8ules
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
78
ueclslon 8ules
CAGL ku|e for creen|ng 9at|ents for A|coho| Abuse
now many #yes" responses? 9robab|||ty h|ft L|ke||hood kat|o
0 presenL Ŵ 43Ʒ 0Ŧ13
ƹ 1 presenL no chanae 1Ŧ3
ƹ 2 presenL + 23Ʒ 4Ŧ3
ƹ 3 presenL + 30Ʒ 13
CACL 8ule for Alcohollsm Screenlna
ueclslon 8ules
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
79
n-1 to |agnose troke |n Acute Vest|bu|ar yndrome (verLlaoţ nvsLaamusţ nauseaţ head
moLlon lnLoleranceţ unsLeadv aalL)
· normal PorlzonLal nead mpulse 1esL
· -vsLaamus ln dlfferenL aaze poslLlons
· 1esL of Skew wlLh prlsm crossover LesL of ocular allanmenL
9reva|ence of trokeť 23Ʒ of dlzzv paLlenLs ln Lhe emeraencv seLLlna are experlenclna a
sLrokeŦ
Pn1S ls neadŴmpulseţ -vsLaamusţ 1esLŴofŴkewŦ
ueclslon 8ules
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
80
n-1 ec|s|on ku|e for |zzy 9at|ents
now many var|ab|es are present? 9robab|||ty h|ft L|ke||hood kat|o
0 presenL sLroke dlaanosls unllkelv nA
ƽ 1 presenL +30Ʒ chance of a sLroke +L8 ƹ 23
ueclslon 8ules
· uv1 rlsk and prevalence ls lncreaslnaŦ
· uv1 and Þulmonarv Lmbollsm (ÞL) ls #be mos
commoo pteveofble cfose of bosplfl Jefb lo be
DoleJ 5fes´Ŧ
· 2 mllllon Amerlcans develop uv1s everv vear and
200ţ000 dle of Lhe assoclaLed ÞLŦ
· Lach vearţ over 23ţ000 people ln Lnaland dle from
venous Lhromboembollsm developed ln hosplLalŦ
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
Screenlna for ueep veln 1hrombosls
81
ueclslon 8ules
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
9at|ent afety
nd|cator
¥ear
-umber of
Lvents
1ota|
Cases
Lva|uated
kate
per
1ţ000
Assoc|ated
Morta||ty
Ʒ change |n
kate (2005Ŵ
2007%
ÞosLŴoperaLlve
pulmonarv embollsm
or deep veln
Lhrombosls
2003 43ţ436 3ţ421ţ093 12Ŧ697 4ţ166
Ŵ14Ŧ31Ʒ
2006 46ţ640 3ţ360ţ843 13Ŧ877 3ţ942
2007 46ţ764 3ţ216ţ372 14Ŧ338 3ţ661
2003Ŵ
2007
136ţ840 9ţ998ţ310 13Ŧ686 11ţ769
Screenlna for ueep veln 1hrombosls
82
ueclslon 8ules
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
9at|ent Group V1 nc|dence (Ʒ%
Medical patients 10-26
Major gynecological, urological, or general surgery 15÷40
Neurosurgery 15÷40
Stroke 11-75
Hip or knee surgery 40-60
Major trauma 40-80
Spinal cord injury 60-80
Critical care patients 15-80
Screenlna for ueep veln 1hrombosls
83
· AcLlve cancer?
· 8edrldden recenLlv ƽ3 davs or ma[or suraerv wlLhln four weeks?
· Calf swelllna ƽ3cm compared Lo Lhe oLher lea?
· CollaLeral (nonŴvarlcose) superflclal velns presenL?
· LnLlre lea swollen?
· Locallzed Lenderness alona Lhe deep venous svsLem?
· ÞlLLlna edemaţ areaLer ln Lhe svmpLomaLlc lea?
· Þaralvslsţ pareslsţ or recenL plasLer lmmoblllzaLlon of Lhe lower exLremlLv
· Þrevlouslv documenLed uv1?
· AlLernaLlve dlaanosls Lo uv1 as llkelv or more llkelv?
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
84
ueclslon 8ules
Screenlna for ueep veln 1hrombosls (uv1)
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
83
-umber of 9os|t|ve I|nd|ngs k|sk C|ass|f|cat|on L|ke||hood of V1
Ƽ1 pLŦ Low rlsk 3Ʒ
1Ŵ2 pLs Medlum 8lsk 17Ʒ
ƽ 2 pLs Plah rlsk 73Ʒ
ueclslon 8ules
Screenlna for ueep veln 1hrombosls (uv1)
1esL CuesLlonť #o oo belleve bf oo sboolJ oo Jo fo
fclvlles bf mfke oot pflo wotse?´
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
kesponse L|ke||hood rat|o 9robab|||ty h|ft
ÞaLlenL answers º?es" 34Ŧ88 + 30Ʒ
ÞaLlenL answers ºno" 0Ŧ18 Ŵ 30Ʒ
n one sLudv of 80 paLlenLsţ Ceorae esLlmaLes Lhe populaLlon
prevalence of elevaLed fear avoldance behavlors Lo be 37Ŧ3ƷŦ
86
Screenlna for lear Avoldance 8ellefs
ueclslon 8ules
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
1he laraesL slnaleţ modlflable facLor affecLlna worker and
our paLlenLs' ouLcomes mav be Lhe psvchosoclal facLorŦ
As sLaLed bv WaddellŦŦŦ
#ŧfeft of pflo foJ wbf we Jo fboo l mf be mote
Jlsfblloo bfo pflo lselfŦ´
87
Screenlna for lear Avoldance 8ellefs
ueclslon 8ules
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
88
Screenlna for lear Avoldance 8ellefs
ueclslon 8ules
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
89
ueclslon 8ules
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
90
Screenlna for uepresslon
· Þrevalence of acuLe depresslon ls 23Ʒ ln AmerlcansŦ
· uepressed paLlenLs 3x more llkelv Lo be nonŴadherenL
wlLh Lhelr medlcal LreaLmenLŦ
· Cf Lhe world's Len leadlna causes of dlsablllLvţ flve are
psvchlaLrlc/addlcLlve condlLlonsŦ
· WlLh approprlaLe LreaLmenLţ 80Ʒ of people wlLh
depresslon wlll recover fullvŦ
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
91
Screenlna for uepresslon
Ask vour paLlenL Lhese quesLlonsť
#otloo be pfs moobţ bfve oo ofeo beeo bobeteJ b feelloo Jowoţ
JeptesseJ ot bopeless?´
Anu
#otloo be pfs moobţ bfve oo ofeo beeo bobeteJ b llle loetes ot
plefsote lo Joloo bloos?´
ueclslon 8ules
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
92
ueclslon 8ules
Screenlna for uepresslon
-umber of #yes" responses 9robab|||ty h|ft
0 Ŵ 20Ʒ
1 + 20Ʒ
2 + 30Ʒ
Þrevalence of acuLe depresslon ls 23Ʒ ln AmerlcansŦ
Þrevalence of chronlc depresslon ls 6Ŧ7Ʒ ln Amerlcans
ueclslon 8ules
9hys|c|an Cua||ty keport|ng ystem
1Ŧ PealLh nformaLlon 1echnoloavť AdopLlon/use of LlecLronlc Medlcal 8ecords (#124)
2Ŧ ulabeLes MelllLusť ulabeLlc looL and Ankle Careţ Þerlpheral neuropaLhvť neuroloalcal
LvaluaLlon (#126)
3Ŧ ulabeLlc MelllLusť ulabeLlc looL and Ankle Careţ ulcer ÞrevenLlon LvaluaLlon of
looLwearŤ ÞrevenLlve Care and Screenlna (#127)
4Ŧ 8odv Mass ndex (8M) Screenlna and lollowŴup (#128)
3Ŧ uocumenLaLlon and verlflcaLlon of CurrenL MedlcaLlons ln Lhe Medlcal 8ecord (#130)
6Ŧ Þaln AssessmenL Þrlor Lo nlLlaLlon of ÞaLlenL 1reaLmenL (#131)
7Ŧ lallsť Þlan of Care (measure #134)
8Ŧ lallsť 8lsk AssessmenL (#133)
uownloadable sllde show aL
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93
1be AffotJfble cfte Ac mfkes f oombet of cbfooes o be lbslclfo Oofll kepotloo 5semţ locloJloo
fobotlzloo loceolve pfmeos btooob 2014 foJ teooltloo f peoflţ beolooloo lo 2015 fot ptofessloofls wbo
Jo oo sflsffcotll tepotŦ
ueclslon 8ules
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
94
9hys|c|an Cua||ty keport|ng ystem
n addlLlonţ phvslcal LheraplsLs are ellalble Lo reporL on a measures aroup relaLed Lo back
palnŦ f a phvslcal LheraplsL elecLs Lo parLlclpaLe based on Lhls measures aroupţ he or she
musL perform all Lhe measures ln Lhls aroupŦ 1he back paln measures lncludeť
· 8ack Þalnť nlLlal vlslL (measure #148)
· 8ack Þalnť Þhvslcal Lxam (measure #149)
· 8ack Þalnť Advlce for normal AcLlvlLles (measure #130)
· 8ack Þalnť Advlce AaalnsL 8ed 8esL (measure #131)
#5evetfl of be ptoposeJ AcO oofll mefsotes flloo wlb bose oseJ lo obet cM5
oofll ptootfmsţ socb fs be lbslclfo Oofll kepotloo 5semŦŦŦ´
ueclslon 8ules
CLLawa 8ules for Ankle lracLure lollowlna 1rauma
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
93
ueclslon 8ules
CLLawa 8ules for knee lracLure lollowlna 1rauma
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
96
ueclslon 8ules
Screenlna for Splnal lracLure
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
97
Pow Þhvslcal 1heraplsLs Can uo 8eLLer
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
C||n|ca| ec|s|on upport 1oo|s
· Move awav from ºasklna permlsslon" from Lhe phvslclan Lo ºmaklna
recommendaLlons" Lo Lhe phvslclanŦ
· knowlna when noL Lo LreaL ls as lmporLanL as knowlna when Lo LreaLŦ
· MalnLaln a llsL of healLh professlons Lo refer paLlenLs Lo when lndlcaLedŦ
· MalnLaln a hlah ºlndex of susplclon" for paLholoav
· CollecL basellne daLaŦ CreaLe svsLemsŦ Þush down daLa collecLlon Lo
everv person ln Lhe cllnlcŦ
· SLandardlze vour LxamlnaLlonŦ Screen low Anu hlah rlsk populaLlonsŦ
· llnd paLLernsŦ
· lollowŴup
98
Pow Þhvslcal 1heraplsLs Can uo 8eLLer
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
9opu|at|on nea|th
Address populaLlon healLh Lhrouah behavlor and acLlve exerclse proaramsŦ Some
posslblllLles mlahL lncludeť
· Smoklna cessaLlon
· Alcohol/urua screenlna
· AdulL welahL loss
· Chlldhood obeslLv
· SLress reducLlon
· ?oaa
· ÞllaLes
· AcupuncLure
· Massaae Lherapv
· Lxerclse booL camps
· Croup supporL proarams (eať depresslon)
· Lncouraae paLlenLs Lo flnd a prlmarv care provlder
99
1hank ?ou
uownloadable sllde show aL
hLLpť//wwwŦ8ulleLproofÞ1Ŧcom
100

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