A
recent conversation with an Occupational Therapist has put some startling
facts
into perspective
The
ASEP forum
The
presidency of ASEP
EP
is a profession independent of a govt. licensure status
Tommy
- an exerpt from your recent ASEP article. . . .
Response
to Dr. Birmbaum's article on nutrition supplements
Matt's
"time bomb" article
A
recent conversation with an Occupational Therapist has put some startling
facts into perspective
Eric Durak
Medical Health and Fitness
Santa Barbara, CA 93111
As a professional who considers much of
the work I do in the "wellness" venue, I have found that - according to
recent events in the world of therapy, I may no longer be able to claim
that tag line. It seems at the AOTA has adopted wellness services into
their professional scope of practice for 2003. This may not have
ramifications for clinical exercise physiologists - until they start working
with health plans to deliver wellness services.
According to the OT practice act - not
only specific therapeutic interventions, but wellness - are now part of
the OT scope of professional practice. If an exercise physiologist
were to have a debate with an OT regarding this issue, the OT would simply
state that wellness should be defined in their scope of practice because
they provide wellness and preventive services to their clients. What
it means from a legal standpoint is that any wellness provider (massage
therapist, exercise physiologist, holistic health practitioner) who receives
Medicare reimbursement for their services may now be charged with practicing
OT without a license.
It is yet another example of how current
healthcare practitioners are squeezing the system to benefit them financially
without considering the needs of patients who are in need of a better overall
health care model. It is also an example of healthcare trying to squeeze
out wellness care in America. Consider the following:
-
In 1999 Medicare began reimbursing the cost
of 20 acupuncture services. Now medical doctors (not Oriental Medical Doctors
- or licensed acupuncturists) attend a weekend course and can provide acupuncture
services in their offices - and receive reimbursement.
-
In 2001 the PT, OT, and dietician professions
sponsored the Medicare Wellness Act. If passed through both houses
of Congress - the MWA will provide billions of dollars for preventive services
by professionals who are not trained in prevention and wellness.
It will, however, shift the balance of power out of the hands of competent
practitioners.
-
In 1989 the Maryland PT association successfully
sued over 50 massage therapists for practicing PT without a license.
These therapists were involved in a clinic and their services were being
reimbursed through a health plan. Most left the profession.
Even in the area of cardiac rehab - which
most PhD-level exercise physiologists feel very competent; there is still
a grey area as to whose services should receive reimbursement for specific
aspects of care. EPs would be aghast to find out that according to
the law - they are not providers of clinical exercise services (with the
exception of some states such as Louisiana, which licenses EPs for cardiac
care). It is a wake up call to exercise professionals who wish to
provide services in the new era of wellness care. According to best
selling author Paul Zane Pilzer (in his book, the Wellness Revolution),
wellness care will supplant healthcare as the next trillion dollar industry
in the US. Those who are poised to promote it will profit from it.
I would personally rather see the EP profession
gather the rewards of providing quality care to the vast majority of Americans
who have a minor medical condition (osteoporosis, weight management issues,
nutrition needs, self esteem issues, and functional fitness needs) than
to see these services be relegated to our current crop of healthcare providers,
who have very little knowledge of the application of preventive and
wellness services to patients. They do what they do well - but it
is not the future of medicine. I hope to see more work in the area of prevention
and healthcare issues in future ASEP publications. It is truly the
future of the profession. I hope we use our resources accordingly.
References
1. Newport, J. (March, 2000).
Only prevention can preserve us. Healthcare Business. pg. 104,
March, 2000.
2. Pilzer, P.J. (2000). The
Wellness Revolution. Wiley and Sons, New York, 2002.
3. Lancotôt, G. (1995).
The Medical Mafia. Key Publishing, Morgan, VT, 1995.
4. Graham, B. and Thomas, B.
(2003). Medicare Wellness Act. http://thomas.loc.gov., Senate
Bill 2232
The ASEP forum
Eric Durak
President - Medical Health and Fitness
"The Cancer Wellness Company"
www.medhealthfit.com
Direct line: 805-692-9929
Toll free order: 888-880-5227
Dear Jason,
I have been reading the ASEP forum boards
this morning with great interest. It seems as though a few of you are putting
in some overtime on EP issues. Ten years ago I was where you are
in terms of my work and frustration in the
field. I now run my own company
, and starting up a new division in cancer wellness - which is what I believe
will be the cardiac rehab of this decade.
I received reimbursement for my clinical
exercise services 10 years ago. In 1994, I wrote the book on insurance
reimbursement for exercise therapy services. In 1999 I wrote what
is now the Cancer Wellness manual that
includes information on how to work through
the healthcare system in terms of receiving some reimbursement.
There are businesses who receive HMO and
MC contracts for wellness services. It has more to do with knowing the
healthcare system as opposed to being the quintessential EP. None
the less - I believe that there are opportunities.
You may wish to visit www.silversneakers.com
for an example of an HMO-based national wellness program. Some
instructors love it - some don't think they make enough money. However
- they all work with HMOs and this program
does receive funding. I am trying
to accomplish the same think with my cancer wellness network.
I would very much like to discuss some
of these issues with you. I will be in Minneapolis in June to teach
a Cancer Wellness workshop. If you are in need of CEUs, then perhaps
you can attend. Let me know what type of work
you do in Rice Lake, and if it is close
to Minneapolis. Many thanks for your work on behalf of EPs
The
presidency of ASEP
Eric Durak
President - Medical Health and Fitness
Santa Barbara, CA
Dear Steve,
My congratulations on your new presidency
of ASEP. It is quite an accomplishment for a non PhD. I doubt
that ACSM would ever have a non -PhD as a president of its organization.
This is due to not only your work - but your foresight.
I would like to again discuss the healthcare/EP
relationship with yourself and ASEP for a moment. In your editorial,
you make the statement that one of the goals of EP status in healthcare
is that of licensure. Since I have been involved with this debate
since 1989, and a member of the 1997 CA SB 891 licensure bill - I
feel somewhat qualified to understand the process of licensure, and its
impact on any profession.
In order to become licensed in a healthcare
profession - an organization must first deal with other medical agencies
(nursing, physicians, therapists, counselors) who review their application
and gut any part of it that is in direct conflict (or perceived conflict)
with their current practice acts. One only has to look at current
physical therapy AND occupational therapy practice acts to see that wellness
now plays a critical role in their job descriptions. If EPs want
to legally hold themselves out at "wellness practitioners", they can now
be perceived as violating the law in most states, thanks to the 2003 OT
practice act. When the application does go into state committee -
it must be passed by a majority of state
legislators. Since most of them
don't think the "practice of exercise" has a high liability - they probably
won't pass it.
My last comment on licensure is a request
for current EPs to look at the Louisana state licensure law for EPs.
Not only did they NOT receive reimbursement (other than previous interventions)
since its enactment in 1995, many licensed practitioners have now let their
status slip because of high fees and no viable outcomes of having licensure
status.
Now comes the fun part. According
to economist Paul Zane Pilzer (author of the best selling "Wellness Revolution"),
wellness insurance is the next big item in healthcare - and may drive the
current $480 billion dollar wellness industry into a $1.5 trillion dollar
industry that will surpass the current healthcare sector in total gross
revenues by 2015 [or sooner].
Many organizations are now doing business
with HMOs, PPOs and health insurance companies. Silver Sneakers in
Arizona (www.silversneakers.com), and Personal Health Approach(www.personalhealthapproach.com)
in NY are
doing business with many health plans
and receiving reimbursements through traditional FFS and capitated contracts.
The nation's largest PPO - American Specialty
Health Plans (www.healthyroads.com)
is doing business with over 7,000 health clubs to subsidize the costs of
health club memberships to corporations. Don't you think it's about
time that health plans subsidize the cost of exercise therapy and prevention?
What health plans are looking for is something that EPs excel at - OUTCOMES.
What I learned in my graduate program was performing outcomes studies -
and I continue to perform follow up surveys and mentor outcomes programs
through my business in terms of quality outcomes.
If EPs are serious about leveling the playing
field - my suggestion is to not waste valuable time negotiating with other
allied health care professionals who don't want to see us in the field
- we should be seeking out state contracts and discussing reimbursement
for clinical exercise therapy programs with insurance companies and HMOs
- - the companies who pay the bills for healthcare in the first place.
According to Pilzer - it is paramount to creating another pie, instead
of wedging into the current one. I truly believe that our "status" in healthcare
will then be attained.
EP
is a profession independent of a govt. licensure status
Eric Durak
Tommy,
I am working with financial consultants
now to grow my cancer wellness business into a major healthcare entity
(independent of what the healthcare world thinks). One only needs to look
at the growth of companies such as HCD (Silver Sneakers) to see that understanding
the contract process is more important that going through the government
to validate our profession.
I believe that EP is a profession independent
of a govt. licensure status. If you look at the history of EP from Harvard
Fatigue, Univ. of Indiana UCSB Inst. of Environ. Stress, and all of the
programs that have come about as a result of EP involvement, we all know
that there has been a major role in development of community programs,
exercise technology, and academic preparation.
From the accreditation standpoint - I think
it is very precarious for an organization that does certification to also
do accreditation. ACSM should not be in the business of accreditation
under any circumstances. It is a conflict of interest and demotes
their standing in the healthcare community. JCHO and CARF do not accredit
doctors and nurses - they accredit facilities. NFTA in Colorado also is
an accrediting body for the fitness and health club profession (www.nfta.org)
They are independent and accept certification from leading bodies.
You can continue to write about what you
are and where we are going. Your wife states that you don't get paid
for ASEP - but as a professor, I see part of your job as moving ideas forward
as well as shaping young minds (which is pretty tough these days).
Be thankful that in today's economy you can do both. A VC friend
of mine states that there are over a trillion dollars in investment monies
not being invested due to today's shakey economy. Eventually they
will move this money - and I hope that some VCs move some towards my healthcare
concept. Eventually I will move from Cancer
Wellness to Total Disease Management through
exercise. I am also looking into becoming a national education director
for HIPAA regulatory processes from the Fed. Govt. This could create
jobs for many EPs and other instructors to become site inspectors, and
in-service education consultants to the fitness industry.
Best to you. I will keep your email
as a reference for where we all think the future of ASEP can be.
A good friend of mine (a long time EP) told me to "associate with the people
with money - and you will have the power". I think future ASEP relationships
should be with healthcare organizations who are moving forward. In
that respect ASEP can do in a decade that ACSM has failed to do over 50
years - become a bone fide member of the healthcare profession.
I strongly recommend you purchase Paul
Zane Pilzer's book - the Wellness Revolution. It will give you some
STRONG inspiration for ASEP directions.
Tommy
- an exerpt from your recent ASEP article. . . .
Eric Durak
Integrating Reason with Intuition:
Before the public can grant professional status to exercise physiology,
it must be recognized as being socially necessary. The public needs
answers to the following questions:
-
Where are exercise physiologists educated?
-
Do they attend technical schools or colleges?
-
What kind of academic courses do they take?
-
Where do they learn their hands-on skills?
-
What are their credentials?
-
Are they nationally certified?
-
Are the academic programs accredited?
-
Where do they work?
POINT #1 - The public does not "grant"
professional status to EPs, other healthcare professionals do. There
are many patients who do not know the difference between a physical or
occupational therapist. The point should be whether they do a good
job and have competent outcomes. Exercise physiology is a medical
and social necessity due to its application in sports training [i.e., Lance
Armstrong, Tiger Woods, etc., who have the finest coaches (Chris Carmichel
is an exercise physiologist), and prove to be at the top of their games].
Its other applications in medicine are rooted in 70+ years of research
that is as good as any other medical studies. Therefore, the need
is in the application. We need to convince healthcare of our efficatiousness,
both from an outcomes and financial standpoint.
POINT #2 - EPs are educted at fine institutions.
Curriculums shouldbe consistant, but may never be, as individual schools
determine what they think constitutes and EP course load. If many
professors are neurophysiologists, this may be the emphasis in academic
programs. EPs should have some level of internship in both healthcare
and academc and research. Since there are so many opportunities to
work in exercise therapy and conditioning "good to great".
In closing, accreditation standards exist
through National Fitness Therapy Association (www.nfta.org)
and most schools are accredited academically. If exercise physiologists
wish to make an impact, they need to balance the academic and the business
side of their profession. I am currently reading Business Think,
by Marcum, and the Wellness Revoluion by Pilzer (a must reading
for any EP).
Response
to Dr. Birmbaum's article on nutrition supplements
To the Editor-in-Chief
I have read Dr. Birnbaum's article on supplements
and have a few comments regarding their use in sports medicine / performance,
and in healthcare. The object of sports is winning. If an athlete
has a better coach, they have an unfair advantage. That is the nature
of sports. This holds true for VO2 max, lactate threshold, muscle
tendon insertion, and percent fast twitch fibers. For persons who
have trouble with this concept, they should not compete.
Taking supplements in sports may contribute
to performance, but according to Cooper (1994), and Wallach (1994), using
supplements is a necessary replacement to the minerals and nutrients lost
during the exercise process. It seems almost irrefutable that anyone who
is involved with scientific training regimes doubts the effectiveness of
supplementation. From the greatest athletes in history, to their
coaches - supplements have been a part of athletic training tables for
decades.
Most of the dissent in the vitamin industry
comes from Physicians, who doubt the effectiveness of vitamins. They,
along with legislators are interested in regulation. Whether or not
vitamins and minerals are regulated does not take away from their effectiveness.
We only need to look at recent medical studies about the problems of prescription
medications and health problems (JAMA, 1999) to see that for most Americans,
choosing vitamins is a relatively good decision. Does that mean they
should take them blindly? Of course not - however, pointing fingers
at a non-regulated industry
(vitamins) is about the same as saying
that because exercise physiologists are not licensed healthcare professionals,
they should not be practicing health programming for persons with medical
conditions.
In my estimation, I take a page from best-selling
author and economist Paul Zane Pilzer. In his "Wellness Revolution"
book, he states that our $248 billion dollar wellness industry will overtake
our current $1.5 trillion dollar healthcare industry in less than 15 years.
Most of this growth will be seen in nutriceuticals.
It is imperative that exercise professionals
understand trends and components of vitamins. What they are, what
they're good for, who is using them, and what amounts constitute a prescribed
dose. Once we have an understanding of some of the fundamentals of
vitamin usage, we will better understand why people use them, and how an
"unfair advantage" at present may simply be seen as a standard of care
in the very near future.
References
Cooper, K.H. (Spring, 1994). Antioxidants
and Health. CBI Magazine, pg. 58.
The Antioxident Revolution. (1994).
New York, NY: Thomas Nelson Publishers.
Wallach, J,D. (1994). Rare Earths.
San Diego, CA: Double Happiness Publishing.
Pilzer, P.Z. (2002). The Wellness
Revolution. New York, NY: Wiley and Sons.
Matt's
"time bomb" article
Eric Durak
Dear Matt,
I am reading some archieve articles from
ASEP, and your "time bomb" article was one of the more impressive reviews
I have read in quite some time. I know that many people state that
exercise physiologists are low persons on the health care food chain -
the only comment that I would make is that in my opinion, exercise physiology
is not part of the health care system.
Health care (or sick care) in the US is
make up of MDs, RNs, PTs, psychologists, OTs, and a variety of techs.
Nowhere in my estimation is there any job description for an exercise physiologist.
Your outline of the TX job for EPs illustrates my point. If someone
in Human Resources is looking for a tech job with a high school diploma,
than it may be the job of ASEP to do exactly what AAPHERD did in the 1960s
in Ohio when the state school board decided to get rid of phys. ed. in
a school district.
National AAPHERD came down on the organization
so hard that within weeks PE was reinstated on the school curriculum.
Of course, that was when AAPHERD had over 60,000 members (before many of
them quit to join ACSM). Now we have many diluted organizations who are
not concerned about one particular aspect of the profession (except ASEP).
However - ASEP is a small organization with not a lot of money, and now
legislative power.
I think that if ASEP truely wants to have
EP as a health care entity - it needs to register this profession (I believe
there is a EP description in the bureau of labor statistics), and to understand
where to go in order to get money for salaries and professional excurtions.
Are you familiar with the Medicare Wellness Act of 2001? This bill,
signed into law by Graham-Foley senators, promoted preventive services
for health enhancement. It was endorsed by many of the nation's allied
health care workers, such as PTs, OTs, RDs, and psychologists - most of
whom will profit from its tenents.
Companies such as Health Care Dimensions
in Phoenix, AZ make millions of dollars each year on managed care contracts
for wellness programs (www.silversneakers.com). However, they contract
out services for exercise
for person over 65 years of age (most
of which have medical concerns) to health clubs such as Ballys and 24 Hour
Fitness. The persons who administer these programs are not EPs, and
make little money in the process of
instructing.
The answer to this problem is to make the
profession of exercise physiology as "necessary" as any other type of program.
Simply put - if we can make money for health care - we are necessary. I
have been there myself. I have billed my services out for FFS insurance,
until the referrals slowed. Then I became dispensable. Now
I own my own
business, and I am at present trying to
build a network of cancer wellness programs (for high end instructors,
EPs, and therapists). I am looking for sponsorship monies to provide a
good hourly rate for those experienced professionals to teach these programs.
I hope that you understand where I am coming
from. I have been in the "profession" long enough to know that being
indepensible means that you can produce more revenue than your rival.
That is part of American business. I
lastly hope that EP professors and students
entering the workplace understand this concept first and foremost as they
begin their careers.
