|Posted by firstname.lastname@example.org on March 26, 2020 at 7:55 AM||comments ()|
Early on in my clinical career, I remember seeing some repeat patients. I wondered why, especially given that it was not injury related, or at least I did not consider the reoccurring conditions as injuries, but more so something that should have been managed. I know, I know, I was young and naïve. I am referring to reoccurring non specific low back pain in middle aged individuals. I asked one of our patients, “so what happened, why have you returned for the same conditioned we treated you for just less than a year ago?” He sort of just shrugged his shoulders to which I responded, “you know, we are just going to do the same things we did before and if you don’t want to come back for this again, I suggest you continue doing this when you leave.” A that moment, I developed the “once a low back pain patient, always a low back pain patient.” Meaning that, you will probably always have to do something to manage this. That concept sort of narrowed to NSLBP, or and later to really any chronic condition or unmanaged condition/injury (more on this later, see What Happens When we Ignore: Most Acute LBP will reside on its own, so why should we treat?) This was over 25 years ago, but I don’t think I lay claim to this concept but I should investigate This was also at a time with little (like $5.00) or no copay, low premiums (if) and reimbursement was open and essentially not contested or capped (remember those days???). A runner with bilateral knee pathology was worth about $300/visit????
I like posing this questions to future practitioners: What would happen if we eliminated all reoccurring conditions and chronic problems? Well first off, we would save global healthcare an obscene amount of money given that chronic conditions consume some of the highest % of healthcare/GDP in both developed and undeveloped countries. We would be without patients? I don’t think this would happen completely, but there might be a shift, in some of the industry in what is keeping people healthier as well as the conditions in which we treat. I was once told be a salesperson I should buy their product because its great for acute injuries or at least the acute phase……………..I said, “that is not where we struggle as practitioners or in healthcare.”
|Posted by email@example.com on March 9, 2020 at 11:05 AM||comments ()|
Motivating our patients, clients and athletes is good for “business.” Yes, business. Let’s first look at the complete philanthropic perspective, a free clinic or service. To really have an impact, you want as much resolution in individual progress as possible. It would not be a good use of resources to keep treating the same people for the same thing over and over because they were non-compliant (doing their part, which is always more than we can ever do with the time we get), as that would limit the overall amount of people you can treat. And in the hybrid (which I think is most of us perform) where you have a clinic or facility that generates revenue enough to cover your overhead and life, you can then afford to give back to your community, you must be somewhat successful in your business. This is not withstanding to those who dedicate their life to giving and ministry.
What exactly are we motivating? I already hinted at it, compliance. At least that is part of it, and a large portion of what we have influence over. Compliance is the amount of commitment our patients/clients have to what we have prescribed to achieve their goals, yes, their goals. I share in the goals, as that is good for my goal as well, success (more on that). This is especially challenging (and quite important) in the world of insurance reimbursement as not only is their dictation in what we will get reimbursed for as far as procedures, but also the number of times we may conduct these procedures. Those outcomes (goal achievement) can also influence on how those payors may treat us in the future. I don’t want to get into a discussion on this too deeply, but there are already tier structures for certain payors on their providers…………….but lets just say that if you can save them money, you will likely make up for it in volume, if that is feasible and of interest.
Aside from the third party payor model, consider the more recent (for some, more recent than others if you are a licensed clinician) approach of out of pocket payor. This is actually what non licensed exercise/fitness/performance leaders experience, whether in a fee for service model or institutional (you work in a facility such as a club, team, institution, in this case you could also be a licensed clinician). Motivating for compliance results in progress, success in the goals set forth. This is proof that what you are doing is working. In today’s health and wellness industry, individuals have been forced to become better consumers of health. This has actually opened up some door for us, maybe closed a few too. The doors closing is that whomever is/was paying, no longer simply just sends the cash over for whatever has been done. Everyone wants to know what they are paying for………..well most.
|Posted by firstname.lastname@example.org on February 26, 2020 at 1:45 PM||comments ()|
How do you get your clients or patients to do what is necessary? For those who began working with people more than a decade ago, have you determined any changes in the populations in which you serve? In other words, is what motivated people ten years ago still the same for today? That’s both the population at large and the individuals. For example, I used to provide a profile comparison for my students in my nutrition course, me in my 20s when I was in college and another of me in late 30s. They included biographic data such as body mass and percent fat/fat-free mass, nutrient intake, time spent in physical activity, time spent sedentary (both leisure and occupation). Student did not know this was me, as I wanted them to be candid. To summarize, when I was in undergrad, I was in a health fitness major, worked at a fitness center as a personal trainer and group exercise leader and trained for body building. In other words, my life was fitness and exercise. I trained hours per day, very strict diets, etc. Fast forward about 15 years and now in a career(s) working to make a name for myself in education and in clinical practice…………..you may have looked at my profile by now and figured I no longer train for body building. I recall after class one day, two students, Gerome and Josh, hanging out with me discussing this assignment on the profile comparisons. “How could this guy just let himself go like that?” I revealed my secret of who this person was, and there was a little backtracking but lead to a great conversation of goals and motivation. In another section and lecture for the course, I would flash this picture up and ask folks if they could identify this infamous body builder……………….to this day, no one.
It makes no difference whether it’s about prevention, care, or enhanced performance (well, that’s not total true, but for the sake of argument), it’s about motivation. We know that both sympathy and empathy can be valuable connections to our clients and patients, but we don’t always have first-hand experience with their conditions. However, we do share something for sure, motivation. So what motivates you do to what you do? I do think its also important to understand that we are also likely promoting, seeing as how this website is more so dedicated to non-invasive (non-surgical non pharma, not against, but not in the wheelhouse) approaches to health, wellness and performance. Of course, we must also keep in mind that not everyone is motivated by the same reasons or uses the same construct. We do however identify some key elements/approaches to motivation, such as intrinsic and extrinsic “reward” mechanisms. These will also be affected by the state of the individual and their control over that state. What I mean is, the psychological profile AND the “moment in time.” We can simplify this moment in time as emotion, and how well a person can use that emotion or how it uses them. A great deal of this in sport psychology in preparing athletes for both competition AND training. What about a non athlete or patient? Its actually quite similar.
So, why is this important to me, and hopefully you? I have also said to my students and clients, “you can be the best scientifically minded clinician, trainer, coach, etc, but if no one is there to train, treat or educate, what good are you to the cause? Or when I get to a point in the lecture about reimbursement, billing, coding etc it would sometimes surprise students and I would even get the response, “but why do we need to discuss this, we got into this to help people.” Well, even a free clinic costs money!