This week we reveal part four and invite you to share your thoughts and opinions with us.

PT Education

The physical therapy profession is in the process of transitioning to a clinical doctorate as the entry level for physical therapists.  The duration of education for the clinical doctorate has in general added one to two semesters of education before clinicians are eligible to sit for the examination overseen by the Federation of State Boards of Physical Therapy.  This added time to qualify to be a therapist has created an effective shortage on the supply side.  This situation is summed up in a report by Lisa Huddleston, “Health Council Releases Annual Vacancy/Age Report and Nursing Demand/Supply Study,” April 20, 2009 addressing therapy needs inCincinnati,Ohio.

At the moment, however, job security for all physical therapists still appears to be solid. According to a report released last week by the Greater Cincinnati Health Council (using data from 28 hospitals in the tri-state area), physical therapists have an average vacancy rate of 13.5% (up from 9.3% in 2007)…., and PTAs and COTAs have vacancy rates of 13.1% and 14.7%, respectively. The report claims that changes to physical therapy education requirements are part of the vacancy problem. “Because physical therapists are now required to have a doctorate degree, Greater Cincinnati will experience a lack of graduates during the transition.”²

The challenge with the shortage in therapists due to education transition and other factors is that universities naturally respond to the effective shortage by increasing enrollment.  This is necessary to meet the demands for patients needing care but will ultimately likely lead to an abundance of therapists at some point in time as the Baby Boomers become less prevalent, demand for therapy diminishes and universities are slow to lower enrollment due to an associated loss of revenue.

The American Physical Therapy Association is trying to stay out ahead of this situation having organized a task force to look at therapy needs from 2010 to 2020.  Their model takes into account various supply and demand variables including education where the APTA estimates a 4% growth rate of graduating therapists from 2010 to 2020.3

As pricing pressure continues to be downward on healthcare services, and therefore likely also on therapist salaries, and the cost of the education to become a physical therapist increases with the change to a doctoral level entry degree, the return on investment question may begin to loom larger in the minds of those who may be considering a career in physical therapy.  As part of the consideration of going to a doctoral level entry degree the APTA should also consider the need to get paid residencies similar to physicians to make the prospect of becoming a PT more realistic.

Subscribe to the HPI Blog to catch the next part in this series as soon as it’s available.

This week we reveal part three and invite you to share your thoughts and opinions with us.

America’s Aging Population

Baby boomers are rolling into their retirement years.  They are a more physically active generation than those in the past and want to stay that way; however, this group hasn’t escaped the challenges of obesity and lifestyle choices that have been detrimental to their health.  They are going to demand healthcare services for their aches and pains and to keep them strong and vibrant.  This group will be a catalyst for greater therapy services related to the increasing volume of total joint replacements and joint resurfacing procedures.  There will also be an increased demand for therapy related to cancer, neurological and other conditions that will arise in this group from the aforementioned lifestyle choices and as a result of living longer than former generations.

An article in January 2011 on Brighthub.com addresses some of these issues and the effect on therapy growth opportunities.

The job outlook for physical therapists is actually very good, with a project[ed] growth of about 30% between the years 2008 and 2018. As part of the field of health care, those individuals that are interested in becoming physical therapists can expect for the increase in employment opportunities due to the growth of the elderly population, as well as the baby boomer generation entering into the age where heart attacks, strokes, and other illnesses become ever prevalent.

The added advancement of medical technology will also help the job outlook, as it may mean that illnesses and diseases that had not or could not be treated before now can, enabling a growth within health care as a whole. Physical therapists will have employment opportunities in hospitals, clinics, outpatient facilities, and even schools, especially those that are in rural areas outside of a main metropolis.¹

Some efficiencies in the use of healthcare will also likely result in this generation, and in the population at large, as the internet has made healthcare information relatively ubiquitous.  Also today’s consumer is more likely than ever to question the traditional paternal nature of healthcare providers and make more decisions about their own health.  The aging population may result in a shift in how therapy is delivered likely with more of a focus on educating the patient to address their own needs rather than being dependent on the clinician to “heal” the patient.  Baby Boomers also appear more open to alternative medicine remedies and therapists will see some increasing competition from massage therapists, athletic trainers, and exercise physiologists depending how liberal state licensing regulations become.

Subscribe to the HPI Blog to catch the next part in this series as soon as it’s available.

This week we reveal part 2 and invite you to share your thoughts and opinions with us.

Payer Changes

American healthcare costs too much.  For anyone who doesn’t know this you have been living in a cave for a long time now.  The issue is in the news again as the Supreme Court debates the merits and legality of the Affordable Care Act (Obamacare).  We have millions of uninsured persons in America, many employers are going to high deductible health plans (someone I was talking to the other day pays over $300 a month for him, his wife and their healthy 2 year old daughter for a plan with a $10,000 deductible), and for those who can’t get their insurance through an employer costs are even higher.  The last figure I saw for this segment of our population was somewhere in the neighborhood of $12-$13,000 annually for a family of four. 

As a result of these statistics payers are looking for ways to scale back to limit the need to increase taxes or limit services, if a government payer, and to keep the bottom line healthy for private payers.  Some version of block payments is likely to be implemented where a single payment will be made for care to a patient involving a spectrum of healthcare employees and services over inpatient and outpatient settings.  For example, if a patient has a total knee replacement the payer will make a single payment for the hospital or surgical center care, the services of the physician and her staff and for therapy, nursing and other ancillary services.  The federal government has done this to some extent with prospective payment schemes but they figured out with the concept of consolidated billing how to take this concept a bit further in getting healthcare providers to do some of their work for them.  For those of you who don’t know about consolidated billing it is a process whereby if a patient is receiving therapy in a SNF but needs some specialized therapy services, say vestibular rehabilitation, in an OP setting, the OP clinic can’t bill Medicare.  The OP clinic must submit their claim to the SNF to get paid out of monies the SNF receives for the care of the patient under prospective payment.  This concept also extends to homecare and simultaneous OP services. 

You can imagine with a block payment system that therapies are going to be somewhere down the list when it comes to getting paid.  The hospitals and physicians will get their cut first and whatever is left over will be parsed out to the remaining providers.  This could result in fewer therapy visits, and perhaps if the physician feels their payment is at risk, no referral for therapy for certain conditions as long as the physician’s reputation stays intact.  It will be interesting to see the relationship dynamics go forward between physicians and ancillary providers as these types of payment structures unfold.   

One consideration for therapists in light of these issues is to look at identifying new cash based services they can offer to keep the patients they have and to get new patients in the door. 

Subscribe to the HPI Blog to catch the next part in this series as soon as it’s available.

This week we reveal part 1 and invite you to share your thoughts and opinions with us.

The business of American healthcare is changing at a very rapid pace; faster perhaps than the rate of scientific advances.  Certainly there are many causes for these changes such as evolving and more complex federal regulations, third party payer guidelines and escalating costs of all services, to name a few.  What effect will these changes have on job prospects for future physical therapists?

When comparing future job prospects I naturally reflect on my profession as a physical therapist (PT) for the past 24 years or so.  When I graduated from Emory University in December of 1987 physical therapy was about as hot of a profession as there could be.  I started interviewing for jobs in November of 1987 and interviewed at facilities from Atlanta, Georgia to Boise, Idaho and parts in between.  I had 13 interviews all together, all at hospitals.  I was offered a position at all 13 sites.  Companies were willing to fly me as a new grad from Atlanta to Arizona, Idaho and Utah and it was not uncommon for many positions to offer a sign-on bonus.

As it turned out I accepted my first therapy job at a reputable hospital in the greater Phoenix, Arizona area a particularly busy therapy market at the time.  To illustrate how hot the job market was for PTs in the greater Phoenix area, I accepted the job at a certain salary in November 1987 to begin work in January of 1988.  By the time I actually started work I had been notified twice that my salary had increased before I ever saw my first patient.  Pretty great huh?

During the time I was in Phoenix I did some PRN weekend work at a smaller hospital from time to time.  I was paid at a rate that is similar to some PRN work I do now in the greater Salt Lake City, Utah area 24 years later.  You newbie therapists (the one or two of you that may be reading this) are probably wondering what happened.  It was a sea change in the way the federal government paid for therapy, primarily in SNF settings, that resulted from the Balanced Budget Act signed into law under former President Clinton.  All of a sudden demand for therapists shrunk virtually overnight.

Now that I’m done reminiscing, hopefully to prove a point about the fluctuations in the job market, I believe there are some parallel forces at work that will influence the job prospects for rehabilitation therapists over the next several years.  Certainly I’m no futurist, but having been in the field for a while now, and having years of experience reviewing federal regulations as a compliance consultant while still working as a therapist I have some thoughts on the matter.  For purposes of this discussion I’ll consider four issues that I believe will have an impact, 1) payer changes, 2) America’s aging population, 3) therapist education, and 4) market forces.

Subscribe to the HPI Blog to catch the next part in this series as soon as it’s available.

I’ve been thinking about how we deliver physical therapy to hospital inpatients of late. I currently work at a hospital that primarily provides care to persons who currently have, or in the past have had, a diagnosis related to cancer. This population of patients presents some unique challenges in the delivery of therapy. Many patients will come to the hospital functioning independently in the community only to receive necessary medical treatment that often weakens and debilitates the patient before making them “better.” When we evaluate these patients on admission we are able to establish a functional baseline, but over the course of their hospital stay our goals and expectations for the patient can be in flux based on the chemotherapy or other medical care the patient receives and the related side effects. Our frequency and modes of treatment may change based on the patient’s current physiological tolerance. It can be challenging for patient and therapist to achieve a certain level of function only to have to repeat work toward the same goal as symptoms wax and wane. Unfortunately, there are also times when the disease process gets the upper hand and physical therapy is no longer appropriate for the patient.

As I’ve continued to think about how to make sure we as physical therapists (PT) address the patient’s wants and needs, I believe we should think about the overall therapy “experience” and how that looks in the context of inpatient hospital care. In juxtaposition to an outpatient physical therapy encounter that some patients have had, they may find the inpatient experience to be less predictable, less under their control, and at times something tiring and downright unpleasant. At the very least it will be a different experience for them. While patients expect a nurse to assist them in going to the bathroom (mind you I’m only talking about the gait part here – the therapists I know shy away from the more personal part of the experience) and tying up the back of their gown, they likely didn’t think about a physical therapist doing the same for them before they came to the hospital. For the patients benefit, I think to consider the experience in three ways; “listened to”, “looked after”, and “let go”.

Listened To
Patients want to be heard; we all want to be heard. As a PT, I need to know what the patient thinks is important. I need to ask them how they were functioning before their admission to the hospital and what barriers they currently see to continuing to function in that way. I need to understand the home environment from the patient’s perspective and identify how I can use the hospital environment to simulate their home environment. I need to hear the concerns of the patient’s family/caregiver and request orders for additional services from the physician if appropriate. There may be times when I need to negotiate what is most important with the patient and caregiver and help us all get on the same page. Most of all, I need to ensure the patient understands I see them as an individual and tailor their therapy plan of care to meet their specific needs while still addressing safety and any other necessary therapy concerns. I need to think of myself as an educator and as a conduit of information for the patient. There may be times I need to be their advocate with the nursing or medical staff.

One small gesture I think we can do as inpatient therapists is to try and schedule a time with the patient for therapy. Though scheduling is not always practical in an inpatient setting, I can at least likely approximate the patient’s wishes by asking during the therapy evaluation if they tend to be a “morning person” or an “afternoon person” and then try to accommodate the patient. The result will likely be less frustration on the part of the therapist and the patient.

Looked After
Therapists tend to be relationship builders. We often see the same patients throughout the course of their stay as we go from place to place within the hospital to treat patients. We get to know varied staff members who may float from floor to floor seeing various patients. We get to know discharge planners in our discussions about durable medical equipment or the need for a patient to be discharged to a community rehabilitation facility. We also get to know and get referrals from varied physicians for patients with a variety of diagnoses. Because of this work pattern therapists can be in a position to advocate for the patient. We discuss issues with patients and their caregivers and have observed them as they function over time. This may be in contrast to a nurse who has only seen the patient through the window of a single shift or two due to scheduling patterns and staffing issues. We should strive to identify issues of concern to a patient as early as possible in their course of stay and correlate that information with other team members to meet the patient’s needs. This behavior may not only make the patient’s hospital stay better, but can also enhance their life after discharge by helping the patient get the appropriate equipment or services.

Let Go
“Let go” to me reflects having done my job well. It means I’ve helped the patient achieve functional goals in therapy. It means I’ve educated the patient and their family and have done my best to address their needs throughout their hospitalization. It means I’ve been their advocate and a good team member so that the “whole” of the patient’s care ends up being greater than “the sum of its parts.” It may also mean knowing when therapy is no longer appropriate and discharging the patient from care, but dropping by to see the patient and be a “listening ear.”

A hospital can be a challenging place to be. While patients see many people throughout the day it can still be a lonely place. It can be a place of big words and a loss of control. It can be a place where when staffing issues arise it seems to the patient more like they are an inconvenience than a human being with significant needs. Hopefully through the pattern of “listened to,” “looked after,” and “let go,” through being sensitive to the patient’s needs and adding a “learned from” variable for us as therapists, we can make the patient’s therapy experience and hospital admission a little more palatable. Though these simple gestures may not show up in improved outcomes data, they will make a difference to the patient and the therapist.

In the study, KPMG examined the current condition of United States hospital labor costs and identified “several trends and benchmarks in relation to hospital nursing labor costs in the United States” which could impact the future of a hospital’s labor strategy.

KPMG compiled the survey responses of 120 senior hospital executive throughout the United States. By surveying those at the heart of the field, KPMG reports that it was able to gain “valuable insight into current challenges and future opportunities” and “better understand the fully loaded cost and productivity of a registered nurse.”

At the time of the survey, two-thirds of respondents was currently making use of traveling or per diem nurses, according to KPMG. Key reasons and decision criteria identified for the use of traveling or per diem nurses were supply and demand, and quality of the traveling nurses. These appeared to be even more important decision factors than cost, the report states.

On average, respondents felt 90:10 was the ideal ratio of full-time employed nurses to traveling or other temporary nurses, KPMG reported.

As the economy begins to show signs of a recovery, and the focus on resource management and total cost of labor is expected to continue, the use of supplemental labor is expected to rise.

To see the entire survey, go to KPMG’s website by clicking here.

Today’s acutely and critically ill patients require sharply tuned alertness and extraordinarily complex care from a team of highly skilled health professionals. Nurses confirm that patients admitted to their units are sicker than ever before

In order to provide the best patient care nurses must invest in educational opportunities that give them up to date knowledge and skills. Although education takes time, learning new information is beneficial to nurses, their employers and patients.

If nurses choose to become certified, this validates specialty knowledge, experience and clinical judgment. Certification validates the nurse’s expert knowledge and skills and therefore positions them for appropriate recognition and a critical sense of confidence and achievement.

Whether certified or not, continuing nursing education gives nurses an opportunity to brush up on knowledge they may not have used recently or to gain a more technical background in their specialty.

Continuing nursing education serves as a viable means of improving the professional competence of the practitioner with the outcome of improved health care.  Ongoing education and experience reduces a nurse’s exposure to risk and better prepares him/her to make informed decisions that encompass a larger scope.

Continuing nursing education can assist individual practitioners in the continual acquisition of knowledge, the extension of professional responsibilities, the expansion of interpersonal skills, and the improvement of problem solving approaches to professional practice.

Continuing one’s education is part of lifelong learning. Participating in lifelong learning is every nurse’s responsibility.

Rosemary Homer RN, MBA directs the Northern Illinois Healthcare Education Network which offers a variety of learning opportunities for nurses. Find out more at www.halliganlynch.com.

 Halligan- Lynch Consulting- Northern Illinois Healthcare Education Network is an approved provider of continuing nursing education by the Illinois Nurses Association, an accredited approver by theAmericanNursesCredentialingCenter’s Commission on Accreditation.”

So, do I promote individuals because they are loyal and dedicated, manage their current role very well, could possibly be trained to advance; but the risk is they may not possess the insight, drive or skills to go to that next level for the company to grow and prosper? Being objective during an in-house assessment can be difficult. One must be able to step back from a situation to provide an unbiased evaluation. Thus, it has been critical for me to seek advice from an outside party for options on HPI’s growth. In a small business, relationships are often more close-knit. If one cannot be neutral in specific circumstances, an objective view is needed. Before a particular plan is pursued, it is vital to have a clear vision of the desired outcome. An outside sounding board is very valuable in this area.

While I feel my first priority should be HPI’s success, it can sometimes be difficult to make tough decisions about current staff. As the company’s leader, my actions should directly reflect my business ethics. These include fair assessment of employees combined with company growth. External advice may very well be needed to bring these factors together. A concrete goal can be established that should make way for the best business decisions.

The value in seeking outside counsel for difficult situations cannot be overstated. A good leader will know if remaining impartial comes naturally, so emotions don’t interfere with business goals. That leader also understands when to call for help from a professional not directly involved—a consultant who can assess and recommend objective courses of action.

I have concluded that the outside sounding board is essential for me to make the wisest decisions for HPI as a whole.

Friend or Foe?

The latest generation to join the nation’s workforce is one of technological savvy and a yearning for success. Known as the “Millennials” for growing up at the turn of the last century, the dynamic group is making headlines for their radically different learning styles and modes of communication, differeing greatly from the Traditionalists, Baby Boomers, and Generation Xers. In light of our nation’s drastic changes in the economic, political, and social arenas, the millenials have proven that total immersion in technology is the way of the future. This vast wealth of knowledge is viewed as beneficial to some, and burdensome to others. Generations who have been in America’s workforce for 20+ years have seen the ability for business to prosper without accessories such as Facebook, Twitter, and LinkedIn. Why then, should previous generations feel comfortable with handing over the reins of industry to this technologically-dependent group?

It comes to no surprise that the millennials do not have the greatest reputation in regard to prospective employers. This generation doesn’t learn by taking notes or sitting through a two hour lecture on the proper conduct within a hospital. It is important that employers remember millennials learn by doing. If this generation is able to learn procedures tangibly (i.e. doing) then questions and uncertainty from new employees may decrease. Along with a different learning style, this generation expects supervisors to respond to questions, email, (and now ‘tweets’) as quickly as the internet can provide answers. Obviously this is an unrealistic expectation that needs to be addressed. Understanding that the industry is changing does not mean that you have to compromise your own integrity to accommodate an incoming generation. Sticking to the procedures and schedule that you know best will set guidelines for incoming employees and aid in their orientation to the hospital conduct.

“My experience is they want to follow the rules and to learn, but they need to be told explicitly what the rules and expectations are,” – Paige Shaughnessy (PhD, CCC-SLP) School of Allied Health Professionals at Loma Linda University, CA.

Millennials crave to learn, but this learning needs to be backed by social support and interaction for this generation to feel they are on the right track. It is important to remember that while substantial differences exist between the generations, we can all learn something from one another. Having an open mind can decrease tension in the workplace. Millennials will be more than willing to listen to you in hopes of becoming more accustomed to the system. Therefore, it is important that you listen to this technological group. Learning from eachother as health care providers will be instrumental in maintaining the most qualified team of nurses. Here are some tips that will help veterans of the industry work with the newbies:

• Be staunch when it comes to your availability for questions, mentoring, etc.
  • setting up a strict time frame (much like professors do with office hours) will condition the new-comers to respect your time AND space
• Keep an open mind
• Understand that YOU didn’t know everything when you first started out either
  • Having patience and being proactive can only be beneficial to you and millennials
  • This generation has to learn more material than their predecessors, yet are expected to do it within the same time frame. Unrealistic? Yes.

For the full article and other helpful information, follow this link.

• All photos must be submitted by August 12, 2011 for consideration.
• A maximum of three (3) photographs may be submitted per participant.
• All photographs must be submitted digitally through OSHA’s website at:
  • http://ht.ly/5t1O4
• The winner will have their photograph(s) displayed in OSHA’s National Office in Washington, DC.
• First place winner will also receive a framed certificate from U.S. Secretary of Labor, Hilda L. Solis.

For more information regarding this contest please visit OSHA’s website for FULL rules and guidelines.

• www.OSHA.gov