In May, I attended a retreat for all directors and administrators of the hospital system for which I work. One of the presenters was a strategic advisor to hospitals nationwide, and he spoke on the topic of how to prepare for health care reform. While his talk was very informative, it was also a bit scary. He outlined several changes that he predicted were on the horizon for all health care practitioners and hospitals. He stated that those entities that do not prepare now for those changes will not survive. Following are some of his predictions:
1. Fee-for-service payments will be adjusted so that reimbursement will cover only efficiently provided care.
2. Reimbursement rates for Medicare patients will decrease.
3. There will be relentless pressure to force efficiency of all providers.
4. Patients will be asked to pay increased copayments, which, for some, will make health care less affordable.
5. Patients will pay increased amounts for insurance premiums.
6. There will be many diagnoses for which hospitals receive a predetermined sum of money and the hospital will decide how to distribute that money to every service that is involved in the care of that 1 patient.
7. There will be increased pressure for practitioners to provide medical care on the basis of evidence-based guidelines and best practices to correct for the fact that currently if the same patient went to 6 different doctors with the same diagnosis (eg, congestive heart failure), she may receive 6 different treatment protocols.
8. Outcome metrics are going to be increasingly scrutinized.
9. Patient care will be required to be highly efficient, protocol-based, patient-centered, and metric-driven.
10. Payment will be tied to value of care and/or performance.
11. Proof of clinical effectiveness is going to be increasingly more important.
The speaker's overall message was that changes are coming and that those who do not prepare for those changes may not survive. He provided a quotation by General Eric Shinseki, retired US Army Chief of Staff, that states, “If you don't like change, you're really going to hate being irrelevant.” I think that the statement is very relevant not only to physicians and hospitals but also to our own discipline of physical therapy. I am not exactly sure why this is a quotation that receives synaptic importance in my memory, but a quotation attributed to Orville Wright came to my mind. He stated, “If we all worked on the assumption that what is accepted as true were really true, there would be little hope of advance.” My interpretative version is that if we as physical therapists rely on the premise that because we have a history as being relevant to the health care system and therefore we will automatically remain relevant, then we may not make the changes required to avoid being placed on a “do not call” list. I believe that as cost-effectiveness is going to be carefully examined by payers of health care monies, our practices will be scrutinized for efficiency and outcomes. John F. Kennedy stated, “Change is the law of life. And those who look only to the past or present are certain to miss the future.” I think that there will be some individuals and entities that proceed with change only because of external force, and some will go forward kicking and screaming all the way. Neither of those is efficient. I have evidence that kicking can result in bruising and soreness, and screaming can result in a hoarse or inaudible voice. I think that we can choose to move forward relatively unscathed and unscarred and retain a voice that will be listened to. We can do that by having evidence that we can enhance the function of the individuals we treat in a very cost-effective way. I believe that we should be proactive by accumulating data that show efficiency of care (best results with the decreased number of visits). We have been making diligent progress in demonstrating that we are a field that is based on evidence-based guidelines and protocols, and we have reliable metrics that support our outcomes. In other words, I think that it is incumbent upon us as the entity of physical therapy to have data that prove our relevance. And, the speaker at the retreat stipulated that “Anecdotes are not data.” Our data must come from rigorous research protocols.
In this issue of the Journal of Women's Health Physical Therapy, Dr Laura Hagan and Dr Christopher Wong provide data regarding gait changes that occur with pregnancy. Dr Carol Figuers and her colleagues outline interventions that are commonly employed for voiding dysfunctions and pelvic pain. Dr Mastrangelo and her colleagues provide data regarding the efficacy of a circuit training regimen for preventing symptoms associated with menopause.
While we are on the topic of change, I have undergone a fairly significant change that I want to make potential authors, or other individuals who may want to communicate with me, aware of. I have a new last name. I did not enter a witness protection program, or change marital status, or have a midlife crisis (though the latter might be fun). I was going to choose the name Eleanor Roosevelt, but that one was already taken. So, now I am Nancy Donovan. Very simply, I was formerly Rich, but now I'm not.
Nancy C. Donovan, PhD, PT
The Publisher and Advertising staff of Lippincott Williams & Wilkins apologize for errors occurring in the January/April 2010 issue of the Journal of Women's Health Physical Therapy. An advertisement from the International Continence Society was inadvertently dropped, and the advertisement is included in this issue. The Section on Women's Health (SoWH) advertising guidelines were overlooked in regard to The Prometheus Group advertisement, and this has since been corrected to comply with SoWH guidelines.
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