OTs and PTs – Support an Academic Therapy Program in Haiti

The Department of Rehabilitation of the Episcopal University of Haiti, Léogâne  needs the help and support of OTs and PTs in the USA.  There are many ways each and every one of us can help.
An overview of the program– The Faculty of Rehabilitation Sciences in Léogâne (FSRL) is a department of the Episcopal University of Haiti (UNEPH). Planning for FSRL began in 2011, when volunteers working at St Vincent’s Center for Handicapped Children realized how helpful it would be for St. Vincent’s to have Haitian therapists. The dream became a reality in Oct. 2015 when the first small class of students enrolled. First-year students take interdisciplinary courses at the FSIL nursing school in Léogâne, which is also a department of the Episcopal University. Second, third, and fourth year students specialize in OT or PT and graduate with a bachelor’s degree in Occupational or Physical Therapy.   The curriculum for the OT program has already been approved by the World Federation of OT, and the PT curriculum is now under review by the World Confederation of PT.  The Haiti Rehab Foundation (HRF), a 501c3,  was formed in 2014 to support the work of FSRL.

DONATE ONLINE: one-time or monthly, at  www.haitirehab.org
MAKE A GIFT BY CHECK made out to Haiti Rehabilitation Foundation.   Send to
Treasurer,  HRF, P.O. Box 183, Hamilton, NY 13346 USA.
$25-pay for learning supplies
$100-pay for 1 course for 1 student
$250-pay all fees, 1 mo., 1 student
$1000-cover cost of 1 faculty vol.
$4000-per year: fund a scholarship that will cover 1 student’s fees, tuition, room & board

THE NEED FOR REHAB IN HAITI is very high.  It is estimated that 1.1 million Haitians have disabling physical and/or mental conditions. There are only about 50 Haitian PTs.  and 1 Haitian OT, who have a bachelor’s degree from overseas, mostly from the Dominican Republic.
There are good programs in Haiti for rehab technicians.  However, rehab technicians don’t practice independently.  They often depend for supervision on the many foreign OTs and PTs who come for short-term medical missions.

(1) Heurtelori, M. & Vilsaint, F. English/Haitian Creole Medical Dictionary/Diksyoné Medikal Anglé Kréyol. Coconut Creek, Florida, EducaVision, Inc.

(2) Netter, F.H. (2014). Atlas d’anatomie humaine, 6e ed. Philadelphia, Saunders Elsevier.

(3) Thompson, J.C. ( 2008). Netter. Précis d’anatomie clinique d’orthopedie. Issy-les-Moulineaux cedex, France, Elsevier Masson.

There is also a need for Visiting Professors and Adjuncts.
For more information

Contact:  Dr. Janet O’Flynn  Acting Dean of FSRL
(509)4397-2658  OR  (315)708-5820


Here’s a Business New Year’s Resolution Everyone Can Keep

Years of consulting with therapists in private practice  has meant helping hundreds of therapists make informed decisions about key aspects of their practice.  Therapists who are optimists, pessimists, ruminators, and procrastinators. Some are analytical, others instinctive. Many have (far too many)  projects and ideas being tossed around and often float from one idea or  to the next making it challenging to decide what to work on. Inherent in helping therapists  make decisions is showing them how evaluate the opportunity cost of proceeding with one option, while eliminating another.

Here’s a resolution – how  about instituting a  new decision-making process in 2017?  In every decision there’s a cost, but there’s also a hidden cost – the opportunity cost. That’s the lost opportunities of all the other options you could have taken instead. The concept of opportunity cost is a powerful one and can help you instill reason and pragmatism behind multifaceted decisions. Weigh not only the benefits, but the costs of every decision you make.

For example –
If you are considering offering a new service and do all the preparations to get it up and running, realize that the “cost” or trade off may be that you don’t have the funds, skills, the time or the “real estate” in your office to offer another service. This comes up frequently when therapists consider running a group versus offering individual services.

If you fail to keep abreast of  a current trend or a new modality  in delivering your service, the “cost” may be your inability to serve your target market as  these new technologies make inroads in improving the delivery of that service – and you may lose clients to the competition who may be embracing the trend.

If you decide to keep employing a staff member with “issues” from chronic absenteeism to poor people skills  the “cost” may be  the time spent doing damage control, which may drain resources, and  could cause others to quit in frustration.

If you spend your time doing the books and handling collections yourself, the “cost” may be the opportunity (and time) to get before prospective clients by networking, or building deeper relationships with your referral sources.

And examine the cost of doing nothing – Don’t fool yourself if you think doing nothing is  neither good nor bad but neutral.  There is indeed an opportunity cost of doing nothing, that is, the failure to reap the benefits of an effective intervention or the cost of inaction. Despite the fact that doing nothing can feel safe and comfortable, especially if you operate from a position of risk adversity or suffer from what some call organizational fatigue, for each new potential project in 2017, make a rule that the cost of doing nothing be quantified and considered. Once the cost of doing nothing  is established as a factor, therapists  often become more comfortable at approximating and considering it.

Every decision has a “cost” and each of these costs impacts either positively or negatively the processes and profitability of your practice.
When making decisions, you can control the quality of the decision, though not the ultimate outcome that occurs. But by understanding and examining the opportunity costs associated with important decisions, we can improve our odds of making good decisions.

Speaking of decisions, 2017 is looking like a year when we will all be challenged to learn  to make decisions together as a crucial element of getting along and getting things done with others. All the best to you, your families and your patients in the new year.  I am filled with gratitude for the opportunity to work and connect with so many of you.

Wondering about Whether to Seek out Yelp Reviews on Your Practice????

Many therapists and other medical professionals remain conflicted  when it comes to Yelp – should they encourage patients to review them on Yelp or stay with more controlled ( and possible  less credible) testimonials planted on their website. Clinicians and other professionals certainly have a right to be concerned about protecting their reputation as social media penetration continues at a rapid rate. As the shift in what people consider private and what they are willing to share on social media continues, it is more important than ever to keep up with what patients will find problematic and what they won’t. Having an open, amicable relationship with your patients is always the way to go while remaining, HIPAA compliant and maintaining professional boundaries. Check out a September 12th NY Times article on the topic by Aaron Carroll:

How Yelp Reviews Can Help Improve Patient Care

Hospitals and many insurance carriers care about patient satisfaction. It especially matters to hospitals because insurance payments can be influenced by how patients rate the care they receive, as well as by the health of the patient, which hospitals usually report. Many people in the health care profession are put off by this. They argue that patient satisfaction scores aren’t necessarily aligned with outcomes. Moreover, they say that trying to improve satisfaction is a waste of time.

It’s possible, however, that patient satisfaction is being rewarded already, and that the efforts we are making to highlight it aren’t helping as much as we think. Almost every study on patient satisfaction uses the Hospital Consumer Assessment of Healthcare Providers and Systems (H.C.A.H.P.S.) survey. Studies show it is correlated with clinical measures of quality, although some other studies dispute this.

Collecting such information is costly, but there may be other sources for quality assessments that don’t require investment from the health care system. In 2012, researchers in the Journal of General Internal Medicine examined online reviews from RateMDs.com and Yelp. They found that a majority of reviews were positive. They noted, however, that patients reported on aspects of care that extended beyond the patient-physician encounter. They were concerned about staff, access to the hospital and convenience. They also cared greatly about the bedside manner of the doctors they encountered.

 Dr. Naomi Bardach, associate professor of pediatrics and health policy at U.C.S.F. Benioff Children’s Hospital San Francisco, and her colleagues looked at Yelp to determine how consumer ratings compared with those of the hospital consumer assessment survey. Of the almost 3,800 hospitals with survey and other data, about 25 percent also had ratings on Yelp. The correlation between Yelp and the survey was quite strong. Moreover, high ratings at Yelp were correlated with lower mortality for myocardial infarctions and pneumonia — and fewer readmissions for those problems as well as heart failure.

A recent study in Health Affairs expanded on this work. Researchers compared the content of Yelp narrative reviews with the factors considered important in the hospital consumer assessment survey. They found that Yelp reviews did cover most things the survey tallied. But they also covered an additional 12 criteria not in the survey.

These included the cost of a visit; insurance and billing; scheduling; compassion of staff; family member care; and the quality of many staff members. All of these things were important to patients, and all might be correlated with outcomes. More important, nine of the 15 most prevalent criteria in reviews were not included in the survey. The use of metrics like the hospital consumer assessment survey assumes that those in the health care system have figured out how best to measure patient satisfaction. They also assume that all the information we need should come from patients or from the medical record.

That’s not how the real world works. In a more recent study, Dr. Bardach found that the perceptions of other family members matter and can also be powerful because they focus on safety in a way that patients may not be able to do. The same is true of those who help care for patients at home and help make medical decisions for them. Their opinions are ignored by the survey. Those publicly available data may even be more comprehensive than that gathered at the behest of payers. The next question is whether the health care system needs to measure satisfaction — maybe the publicly available data, like at Yelp, is sufficient. Could those data be used alone to incentivize providers?

A couple of weeks ago, my colleague Austin Frakt wrote a column on hospital quality and market share. He argued that people could improve their health by choosing a hospital that has a higher quality rating. He also underscored that patient satisfaction scores are often aligned with quality and with better outcomes.

He highlighted a paper published in The American Economic Review that looked at how performance of hospitals was related to market share. Conventional wisdom holds that patients lack information on quality and that they cannot tell, or favor, providers who seem better. But researchers found that hospitals that performed better, on both outcomes and process-based measures, tended to have greater market share, and experienced greater market growth.

Further, they found that as patients shifted to hospitals with higher performance, that change alone drove a significant amount in the improvements seen in overall survival rates for a number of conditions. Overall survival improved, in part, just because patients shifted from hospitals with lower quality to higher quality. If patients had the ability to choose between hospitals, they tended to gravitate to those with higher performance.

In other words, this may be an area of health care where the free market is working. When allowed to choose, patients seem able to discern quality — as they define it — and gravitate toward it. It’s not clear that we need to be forcing the issue with measurement and reimbursement. It’s important to recognize, though, that this was a study of Medicare patients, all of whom arguably have more flexibility in terms of hospitals and doctors than those with private insurance. Those with private insurance often are restricted by “narrow networks” and directed to a few facilities and offices.

Americans cry out for more choice in their health care. This sometimes gets translated to mean a choice of insurance companies. But Americans with government-provided Medicare, who have the least choice of insurers, have the most choices when it comes to providers. And they seem to use that freedom to choose providers who perform better. I asked Dr. Bardach about this. “It’s still unclear how people are getting the information to choose the hospitals, but the power of stories is likely an important part of why Yelp and other online reviews are compelling,” she said. “Stories add nuance and context to the otherwise somewhat sterile numbers that the H.C.A.H.P.S. produces.” Research shows that patients reward quality on their own — when they can. We might just need to make it easier for more of them to do so.


A NY Times Shout Out to Occupational Therapists as the Original Recylcers/Life Hackers/ Re-Puposers That We Are

Barbara Beskind, an Occupational Therapist going STRONG at age 92 gets a great mention in this week’s NY Times.

Hacks Can Ease the Trials of Aging

Marie Tae McDermott

When Barbara Beskind, 92, had trouble reaching foods in the back of her refrigerator, she installed a lazy susan on an inside shelf. The revolving tray makes items much easier to reach. Ms. Beskind, a former occupational therapist in the Army who has age-related macular degeneration, a disease that reduces her central vision, also attached small tactile bumps to the “Answer” button and the “2” and “8” keys on her phone, making it easier for her to respond to and make calls.
Many older people, like Ms. Beskind, are forgoing high-tech gadgetry in favor of common – and usually much cheaper – items from office supply and hardware stores, repurposing them to solve everyday problems. Sugru, a moldable putty that turns into rubber, can be used to round out sharp corners on furniture in order to prevent injuries. Rubber bands can be affixed to cups to make them easier to grip. A clothespin can be clipped to the rim of a cup with a drinking straw taped to it to hold the straw in place. A pants hanger can hold a cookbook open at eye level.

Glen Hougan, who teaches industrial design at the Nova Scotia College of Art and Design, calls creative and resourceful repurposers like Ms. Beskind hackers, a term often applied to computer programmers who develop creative workarounds, or hacks, to particular problems. He began researching hacks designed to ease the burdens of aging in the early 2000s, after finding that many of the store-bought items that were available to the elderly were sterile, generic and lacking in variety. One of his favorite hacks involves hanging an old stocking in a shower with a bar of soap tucked into the foot. As the soap gradually shrinks, it remains inside the stocking instead of a becoming a slipping hazard on the floor. The slightly abrasive nylon stocking material has the added benefit of exfoliating the skin.

As part of a fellowship at the Center for Innovation at the Mayo Clinic, Mr. Hougan interviewed residents at a nursing home and found that they hacked products for a variety of reasons. Some could not afford to buy new things on a fixed income. Others had a background in engineering or design and liked the challenge. For some who grew up during the Great Depression, resourcefulness was a lifelong habit.

The most common adaptations centered around making prescription medications easily accessible and trackable yet portable enough to carry to the doctor’s office, Mr. Hougan found. The organizational systems varied but generally consisted of a calendar tacked to the refrigerator, a spreadsheet recording the names and dosages of each medication, and dollar store bins or shoe boxes arranged in drawers.

A Pew research study found that many older people lack digital literacy and remain skeptical about the benefits of learning to use the latest technology, or find that off-the-shelf products fall short.

“When I’ve tried prescription management apps and entered multiple medications, I’ve found them to be quite a hassle,” said Dr. Leslie Kernisan, a 40-year-old geriatrician in San Francisco who writes about geriatrics and technology on her blog, GeriTech: In Search of Technology That Improves Geriatric Care. She finds that many of her older patients bring in written paper logs of their daily medication use, which can be easier for both doctors and patients to use. “In fact, I find that paid home caregivers and agencies also prefer paper records, even though their workers are clearly adept with smartphones,” she wrote in an email.

To help his design students better understand the challenges of aging, Mr. Hougan had them wear an “empathy suit” — a specially crafted suit that emulates the physical sensations the elderly go through on a daily basis. The suit includes shaded goggles that create a narrow field of vision. The suit’s legs are tethered together so the wearer has limited mobility and must shuffle instead of walk. Headphones muffle atmospheric sounds. Gloves limit the ability of fingers to manipulate objects, and the wearer breathes through a straw to simulate having diminished lung capacity.

Many of the students who donned the suit expressed how much they dreaded growing old. Mr. Hougan now calls it the “aging/ageist suit” and uses it in workshops as a tool to talk about the psychological effects of aging and to confront biases about growing old. The exercises helped him to revamp a number of home health care products for his design studio, BlueZone Design, including a redesigned, foldable bedside commode that can be easily squirreled away if visitors drop by.

Ms. Beskind, the 92-year-old who installed the lazy susan in her fridge, has put her resourcefulness to good use. Since 2013, she has worked as a designer at the global design firm Ideo, where she is developing an idea for eyeglasses equipped with a micro camera, earpiece and facial recognition software that would make it easier for those with central vision problems like hers to recognize others.

Ms. Beskind’s presence at a prestigious design firm provides a unique perspective. “Designers think they can put themselves in the shoes of the aging, but you don’t really know until you’ve lived with the realities,” she said. “Seniors are living longer and more productive lives. This community is an untapped resource for designers. We need more designers open to working on what works for us.”

Yes! What Happens with Uber Worker Classifications will have an impact on Heathcare!!

I have said this many times in my webinars on Independent Contractors vs. Employees – What You Need to Know – One of the best things UBER has done is not making cabs easier to get, but bringing the issue of independent contractors to the forefront.  As a new lawsuit in NYC brought against Uber was announced today, here are some recent articles about the issue that it pays to stay on top of.

Reprinted from the NYTimes Friday April 22, 2016
Uber Settles, But Drivers Will Remain Freelancers
Mike Isaac reported from San Francisco and Noam Scheiber from Washington.

SAN FRANCISCO — Uber has long been embroiled in a debate over the status of its drivers: Should they be independent contractors or full-time employees? Uber says that as independent contractors, its drivers get flexibility. Their freelancer status also lets the company sidestep the costs of full-time employees, including paying minimum wage and the employers’ share of Social Security. But labor groups and lawyers have argued that Uber drivers should be classified as employees to receive worker protections.

On Thursday, Uber moved a step closer to getting its way. The company reached a settlement in a pair of class-action lawsuits in California and Massachusetts that will let it continue to categorize drivers in those states as independent contractors — a landmark agreement that could have lasting implications for the long-term viability of the ride-hailing service. Under the settlement, filed in the United States District Court in the Northern District of California, Uber will pay as much as $100 million to the roughly 385,000 drivers represented in the cases. The company also agreed to several concessions to appease driver concerns, including giving more information on how and why drivers are barred from using the app, as well as aiding in creating new “drivers associations” in both states.

“Importantly, the case is being settled — not decided,” Shannon Liss-Riordan, the attorney representing the drivers in the suit, said in a statement. “This case, however, with this significant payment of money, and attention that has been drawn to this issue, stands as a stern warning to companies who play fast and loose with classifying their work force as independent contractors,” Ms. Liss-Riordan said.

The settlement is a significant victory for Uber on the matter of its drivers’ status. By keeping its drivers as contractors, the San Francisco-based company can keep its costs low. And while the settlement applies only to two states and is nonbinding elsewhere, the agreement and the changes that Uber is adopting may influence regulators in other places where the issue has surfaced. Drivers value their independence — the freedom to push a button rather than punch a clock, to use Uber and Lyft simultaneously, to drive most of the week or for just a few hours,” Travis Kalanick, chief executive of Uber, said in a company blog post announcing the settlement.

“That said, as Uber has grown — over 450,000 drivers use the app each month here in the U.S. — we haven’t always done a good job working with drivers,” he wrote. “It’s time to change.”

The agreement, which is subject to approval by Judge Edward M. Chen, who is presiding over the cases, says Uber must pay $84 million to the plaintiffs represented in the case. Uber will dispense an additional $16 million if the company holds an initial public offering and the average valuation of Uber increases to one and a half times that of its last financing round. In December 2015, Uber was valued at $62.5 billion, making it the most valuable private technology company in the world.

The class actions that are being settled were originally filed in 2013 and became the biggest suits in terms of the number of drivers represented. Uber still faces litigation about driver status in other states, including similar lawsuits in Florida, Arizona and Pennsylvania. Last June, the California Labor Commissioner’s Office said Barbara Ann Berwick, a former driver for Uber, should have been classified as an employee, not an independent contractor. That case, which does not apply to drivers other than Ms. Berwick, is being appealed by Uber.

The settlement’s changes are aimed at reducing points of contention for drivers. In the past, Uber has been able to boot drivers from its platform with little explanation, something that Uber said it would no longer be able to do. The company published a lengthy document detailing all the reasons a driver may be deactivated, from unsafe driving and carrying a firearm — which is prohibited — to using drugs and alcohol.

Uber said it would also provide drivers with more information about their ratings system — a measurement based upon individual scores from passengers — and how ratings were calculated. The company is exploring creating an appeals process for Uber drivers who have been deactivated because of a low rating. Uber also agreed not to deactivate drivers who regularly decline to accept requests for rides from passengers, a practice that previously would contribute negatively to a driver’s overall standing with the company. Instead, drivers may be temporarily logged out of the app and unable to accept new requests if they are “consistently not accepting trip requests.”

“We know that sometimes things come up that prevent you from accepting every trip request, but not accepting dispatches causes delays and degrades the reliability of the system,” the company said in its newly published driver deactivation policy.Uber penalizes drivers who accept trips from riders and then cancel them shortly thereafter. Each city will have a maximum cancellation rate based on the average cancellation rate of the drivers in the area, the company said. It could eventually deactivate those who persistently exceed the rate. Uber said many of the changes were a part of its overall maturation process, as it has grown from a small start-up to a global organization in roughly six years.

Yet many of the policy changes Uber announced as part of its settlement — particularly changes to its protocol on deactivating drivers over their cancellation and acceptance rates — appear designed to defuse the plaintiffs’ arguments that Uber drivers should be classified as employees rather than independent contractors, as the company maintains.

“This is Uber relinquishing a small amount of control in two areas where critics have argued that the Uber-driver relationship looks like hiring and firing,” said Seth Harris, a former deputy labor secretary in the Obama administration and co-author of a recent paper arguing that Uber drivers occupy an ambiguous middle ground between contractor and employee. “It’s a tweaking of the relationship to move the classification closer to the factors that define independent contractor and a little bit further away from factors that define employee.” Other legal experts said that Uber drivers would appear to retain many of the characteristics of employees even under the company’s proposed changes.

For example, the fact that drivers whose acceptance rates are too low could be shut out of the app for short periods of time, and that those with unacceptably high cancellation rates could eventually be deactivated from the platform, may suggest a level of control that is normally reserved for employees rather than contractors.

“Ultimately this is a deterrent to drivers actually refusing to accept trips,” said Rachel Bien, an employment lawyer at Outten & Golden LLP who has litigated similar cases. “If it’s the kind of business that needs a driver to be at a certain place at a certain time regularly, it’s not a business that’s suitable for independent contractors, who should have the freedom to choose which jobs they want to do and when they want to do them.”

Ms. Bien also points out that unlike what is frequently the case with true contractors, Uber drivers will not be able to negotiate the price of the service they provide customers. They will also continue to be deactivated if their ratings from customers are low and don’t improve. The proposal to create an association of drivers in California and Massachusetts that would meet with company officials quarterly to discuss issues of importance to drivers also raised eyebrows in some quarters.

“If Uber is going to be genuine about this, I think it’s a very, very good move forward,” said Joesph Sandoval DeWolf, president of the California App-based Drivers Association, an organization that claims to represent more than 2,500 ride-sharing drivers in Southern California. But he expressed skepticism that this would be the case, saying that whenever the association has asked to meet with Uber to discuss drivers’ concerns in recent years, it has been told that Uber will only meet with individual drivers, not any association representing them, which he said was not effective.


Reprinted from the NYTimes – Wednesday May 11, 2016
A Guild, Short of a Union for NY Uber Drivers – Noam Scheiber and Mike Isaac

Uber announced an agreement on Tuesday with a prominent union to create an association for drivers in New York that would establish a forum for regular dialogue and afford them some limited benefits and protections — but that would stop short of unionization. The association, which will be known as the Independent Drivers Guild and will be affiliated with a regional branch of the International Association of Machinists and Aerospace Workers union, is the first of its kind that Uber has officially blessed, although Uber drivers have formed a number of unsanctioned groups in cities across the country.

“We’re happy to announce that we’ve successfully come to agreement with Uber to represent the 35,000 drivers using Uber in New York City to enhance their earning ability and benefits,” said James Conigliaro Jr., the guild founder and assistant director and general counsel at the International Association of Machinists District 15, which represents workers in the Northeast. The agreement is Uber’s latest attempt to assuage mounting concerns from regulators and drivers’ groups about the company’s labor model, which treats drivers as independent contractors. That model helps Uber keep its labor costs low, but it excludes drivers from coverage by most labor and employment laws, such as those that require a minimum wage and overtime.

That has spurred public disagreements, and many drivers have organized in unofficial groups to gain more rights. The prospect of unionization has loomed at times; lawmakers in Seattle voted last year to approve a bill allowing drivers for Uber and other ride-hailing apps to form unions. In response, Uber, which is based in San Francisco, has been striking deals to tamp down the problems — with the proviso that the company be able to continue classifying its drivers as contractors and stop short of allowing drivers to unionize. Last month, for example, Uber reached a settlement in a prominent class-action lawsuit with drivers who had contested their contractor status. Under the settlement, the company agreed to pay as much as $100 million and put less pressure on drivers to accept all rides; drivers will, however, continue as freelancers.

Uber faces other labor-related hurdles. Along with Lyft, a competing ride-hailing service, the company this week withdrew operations from Austin, Tex., after losing a battle with the City Council over the nature of its background checks for drivers.

Under the terms of the deal in New York, which will be in effect for five years, a group of drivers who are guild members will hold monthly meetings with Uber management in the city, where they can raise issues of concern.

The drivers will be able to appeal decisions by Uber to bar them from its platform, and can have guild officials represent them in their appeals. In addition, they will be able to buy discounted legal services, discounted life and disability insurance and discounted roadside help for problems they encounter while driving.

Yet unlike a traditional union, which contractors typically cannot form, guild members will not be able to bargain over a contract with the company that would stipulate fares, benefits and protections. Uber will continue to determine most of these elements unilaterally, albeit with more input from drivers

The machinists union has also indicated that for the duration of the five-year agreement, it will refrain from trying to

The machinists union has also indicated that for the duration of the five-year agreement, it will refrain from trying to unionize drivers, from encouraging them to strike and from waging campaigns to have them recognized as employees rather than independent contractors.

“It’s important to have immediate assistance in the industry and this is the structure that provides that,” said Mr. Conigliaro.He emphasized, however, that drivers did not waive any labor rights by joining the guild, and that if Uber drivers were found to be employees at any point during the agreement, the union could try to unionize the drivers at their request.Uber said the agreement would help smooth relationships with drivers, whose frustrations have grown with recent fare cuts and policy changes .“Communication is important,” said David Plouffe, Uber’s chief adviser. “On price cuts, we haven’t always had the best forum to discuss and share data — how price cuts work, what we see afterward.”

Mr. Plouffe said that as a result of discussions with drivers in certain parts of the country, Uber had adopted a number of changes, like a pilot program to charge riders when a driver has to wait for more than two minutes. With the agreement, Uber also wins an ally in its effort to change the New York State law that levies a nearly 9 percent tax on black car rides but that does not apply to taxis. (There is a 50-cent surcharge on yellow taxi trips.) Uber says the law unfairly singles out parts of its service. Under the terms of the deal, the machinists union will help Uber lobby the State Legislature to treat all hired vehicles equally.

Mr. Plouffe said the money likely to be saved from changing the law would flow to drivers’ bottom lines, and some of it would be used to help set up a benefits fund that the guild would administer and whose scope it would determine. Among the potential new benefits is paid time off for drivers. Uber was not seeking to replicate the guild idea outside New York, which differs from other cities in that a much higher fraction of Uber drivers use the platform full time or close to full time, Mr. Plouffe added. Also on Tuesday, Uber said the Freelancers Union, which supports independent workers, will advise the company on how to create portable benefits for its drivers and other gig economy workers. Sara Horowitz, the group’s founder and executive director, praised the agreement as a bold step that would become “part of a larger strategy for this new work force.”

The agreement drew a mixed reaction from drivers. Eric Grant, a veteran Uber driver who recently served on a panel in Seattle that heard appeals from fellow drivers who had been deactivated — part of a special pilot program in that city — said Uber’s new appeals program was a much-needed change. “One of the issues they have had in the past is that they deactivate people willy-nilly, without any appeals process,” Mr. Grant said.

Others, particularly those involved in competing attempts to organize Uber drivers in New York, were skeptical. Abdoul Diallo, who helped found an association of drivers in New York, which is called the Uber Drivers Network and claims about 5,000 members, said that the new organization sounded “bogus” and that the guild was no substitute for an actual union.Mr. Diallo said deactivation was relatively far down the list of concerns for most drivers in his organization. “First and foremost, price cuts and commissions matter most to drivers,” he said.

The machinists union said no topic was off the table in the guild’s discussions with Uber, including fares and commissions.Mr. Diallo’s group, meanwhile, is encouraging drivers to sign cards that will allow the Amalgamated Transit Union to represent them; more than 5,000 drivers have signed.

Others, particularly those involved in competing attempts to organize Uber drivers in New York, were skeptical. Abdoul Diallo, who helped found an association of drivers in New York, which is called the Uber Drivers Network and claims about 5,000 members, said that the new organization sounded “bogus” and that the guild was no substitute for an actual union.

Mr. Diallo said deactivation was relatively far down the list of concerns for most drivers in his organization. “First and foremost, price cuts and commissions matter most to drivers,” he said. The machinists union said no topic was off the table in the guild’s discussions with Uber, including fares and commissions. Mr. Diallo’s group, meanwhile, is encouraging drivers to sign cards that will allow the Amalgamated Transit Union to represent them; more than 5,000 drivers have signed.

What Happened in Wisconsin is Good News for all Physical Therapists!

This is big news for all physical therapists, not just those practicing in Wisconsin. What happens in one part of the country tends to get rolled out in others, and this sets a precedent for other states to follow. It also supports the growing trend that I talk about frequently that involves all healthcare providers reaching to practice to the maximum of their licensure.

November 24, 2015 – Introduced by Representatives Sanfelippo, Ballweg,
Duchow, Edming, Horlacher, Kitchens, Knodl, Kremer, Krug, Macco, A.
Ott, Quinn, Rohrkaste, Swearingen, Tauchen, C. Taylor, Thiesfeldt, Tittl
and Weatherston, cosponsored by Senators Wanggaard, Vukmir, Gudex,
Kapenga, Nass and Stroebel. Referred to Committee on Health.
AB549,1,3 1An Act to renumber and amend 448.50 (4) (b); to amend 462.04; and to create
2448.56 (7) of the statutes; relating to: the authority of physical therapists to
3order X-rays and granting rule-making authority.
Analysis by the Legislative Reference Bureau
This bill allows for X-rays to be ordered by physical therapists who satisfy
certain criteria.
Under current law, X-rays may generally only be performed if authorized
pursuant to a prescription or order issued by one of several types of licensed medical
professionals specified under current law. This bill adds licensed physical therapists
to this list of licensed medical professionals authorized to prescribe or order the use
of diagnostic X-ray equipment. The bill provides, however, that a licensed physical
therapist may only order X-rays if the physical therapist satisfies one of certain
conditions specified in the bill. In addition, the bill provides that the physical
therapist must, when ordering X-rays, communicate with the patient’s primary care
physician or an appropriate health care provider to ensure coordination of care,
unless certain criteria that are specified in the bill apply.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:

1Section 1. 448.50 (4) (b) of the statutes is renumbered 448.50 (4) (b) (intro.)
2and amended to read:

AB549,2,43 448.50 (4) (b) (intro.) “Physical therapy” does not include using any of the
AB549,2,8 51. Using roentgen rays or radium for any purpose, using except that “physical
6therapy” includes ordering X-rays to be performed by qualified persons, subject to
7s. 448.56 (7) (a), and using X-ray results to determine a course of care or to determine
8whether a referral to another health care provider is necessary.
AB549,2,10 92. Using electricity for surgical purposes, including cauterization, or
AB549,2,11 113. Prescribing drugs or devices.
AB549,2 12Section 2. 448.56 (7) of the statutes is created to read:
AB549,2,1513 448.56 (7) Ordering X-rays.   (a) A physical therapist may order X-rays to be
14performed by qualified persons only if the physical therapist satisfies one of the
15following qualifications, as further specified by the examining board by rule:
AB549,2,1616 1. The physical therapist holds a clinical doctorate degree in physical therapy.
AB549,2,1817 2. The physical therapist has completed a nationally recognized specialty
18certification program.
AB549,2,2019 3. The physical therapist has completed a nationally recognized residency or
20fellowship certified by an organization recognized by the examining board.
AB549,2,2221 4. The physical therapist has completed a formal X-ray ordering training
22program with demonstrated physician involvement.
AB549,2,2523 (b) When a physical therapist orders an X-ray, the physical therapist shall
24communicate with the patient’s primary care physician or an appropriate health care
25practitioner to ensure coordination of care, unless all of the following apply:

11. A radiologist has read the X-ray and not identified a significant finding.

AB549,3,22 2. The patient does not have a primary care physician.
AB549,3,43 3. The patient was not referred to the physical therapist by another health care
4practitioner to receive care from the physical therapist.
AB549,3 5Section 3. 462.04 of the statutes is amended to read:
AB549,3,13 6462.04 Prescription or order required. A person who holds a license or
7limited X-ray machine operator permit under this chapter may not use diagnostic
8X-ray equipment on humans for diagnostic purposes unless authorized to do so by
9prescription or order of a physician licensed under s. 448.04 (1) (a), a dentist licensed
10under s. 447.04 (1), a podiatrist licensed under s. 448.63, a chiropractor licensed
11under s. 446.02, an advanced practice nurse certified under s. 441.16 (2), or a
12physician assistant licensed under s. 448.04 (1) (f), or, subject to s. 448.56 (7) (a), a
13physical therapist licensed under s. 448.53.

Piecemeal Healthcare Mergers Fly Under Radar

 Reprinted from the NY Times April 9th 2016 – written by Reed Abelson

Federal officials are expected to argue in court starting Monday that a large hospital merger in the Chicago area could hurt consumers and should be stopped. It would be the latest in a series of efforts by regulators to push back against a wave of consolidation among major health care providers.

But a frenzy of smaller transactions is also profoundly changing the landscape, many of which face little regulatory resistance. The deals are often for a couple of doctors here, or a hospital there, making them too small to attract much attention. But as those deals add up, they are creating groups that in some cases dominate local or regional markets. And they are raising questions about whether the gaze of antitrust officials is directed in the right place.

“There’s a lot of consolidation going on at a lot of levels,” said Leemore S. Dafny, a former federal official who is a health economist at Northwestern University. She added, “I don’t think the antitrust laws are set up to stop it.” Doctors and hospitals are making the calculation that bigger is definitely better. Consolidation, they say, helps them better coordinate care and manage patients, making care more effective and less expensive.

Skeptics, however, say that the small combinations can eventually translate into higher costs. By gaining market share, they say, hospitals are able to charge more for their care and gain more influence about where patients are sent for lucrative services. Regulators, meanwhile, are left with limited information about the smaller deals, including answers about whether they diminish competition, leading to higher prices and lower-quality care.

 Dr. Farzad Mostashari, a former health official in the Obama administration, describes what is taking place as “creeping consolidation” — being done at a pace that keeps it away from prying eyes. “If you move slowly enough, maybe nobody will notice,” he said.

Many of the smaller deals go unreported, leaving any tally of them incomplete. But at least 940 health care service transactions took place last year, up from about 480 in 2010, according to Irving Levin Associates, a research firm. This mix of deals, which involved groups like physician practices, hospitals and nursing homes, totaled some $175 billion.

Because of the consolidation, patients are more likely to be getting care from providers with formal ties to one another. The doctor who is employed by a hospital, for example, may send a patient for a CT scan at a facility owned by the same hospital. Patients may be discouraged from going to a provider outside a given network, either by their insurer or their doctor.

The combinations taking place include smaller hospital mergers, like one in Arizona in March, when two hospitals merged. The same month, Baptist Health, a small hospital group in Kentucky, said it planned to reach into Indiana to add another hospital. Neither of those deals has generated significant attention.

The difference in regulatory attention is particularly stark in Illinois.

The hospital deal in Chicago, between Advocate Health and NorthShore University HealthSystem, brings together two large systems, including hospitals and doctors’ groups. It was announced in 2014 and involves more than 6,000 doctors. Advocate and NorthShore say they will promise not to raise their prices above inflation. They also say they plan to introduce a health plan that will be cheaper than comparable policies offered by the insurers in the market.

But the deal is being opposed by the Federal Trade Commission in a case expected to start Monday at the United States District Court for Northern Illinois.

New WCPT report advocates for PT involvement in disaster management

Physical therapists should be considered central to disaster management, and an intrinsic part of planning for and responding to events such as earthquakes and floods. That is the message of a major new WCPT publication. 

The report points to the need for high quality rehabilitation after disasters. But it also emphasises that the role of physical therapists is not limited to direct provision of rehabilitation. It embraces preparedness and recovery and can include assessment, coordination, psycho-social support and advocacy. The in-depth report emerged from discussions between WCPT and physical therapists involved in humanitarian responses, who identified a need to advocate for rehabilitation professional involvement in all phases of disaster management.

It was informed by a project advisory group including representatives from the International Committee of the Red Cross (ICRC), Mèdicins Sans Frontières, CBM International and WCPT member organisations in Japan and the Philippines. “It is an impressive document, very timely, and will be a great resource for physical therapists, in particular those involved in the disaster continuum as well as student education,” said WCPT Vice President Margot Skinner, who was a member of the project advisory group. This month marks the fifth anniversary of a massive earthquake and tsunami in Japan.

“For Japanese physical therapists who have experienced earthquakes and other disasters, the report is well organised and has structured information reflecting on their own activity and describing activities and practice in other disasters,” said Kazuto Handa, President of the Japanese Physical Therapy Association. WCPT’s Professional Policy Consultant Catherine Sykes co-authored the report with Pete Skelton, a London-based physiotherapist and Rehabilitation Project Manager with Handicap International who has worked as part of emergency responses in Nepal, Gaza, Iraq, the Philippines, Libya, Jordan and Haiti.  “Disasters are a growing global problem,” said Pete Skelton, “and while there is often a huge amount of goodwill from physical therapists around the world after a disaster has struck, it can be difficult to know how best to help. When properly prepared, physical therapists can play a vital role in disaster response, but sometimes well intended volunteers can undermine existing locally led emergency work.”

“This guide provides essential information to those interested in national or international disaster response, introducing key international guidance and evidence. Critically, it is also designed to help physical therapists plan and prepare for disasters before they occur, and to support those who are re-building after a disaster has hit.” The Nepal Physiotherapy Association (NEPTA), which played a major role in organising physiotherapy response following the major earthquake in April 2015, was one of the organisations providing case studies for the report. Others included Handicap International, ICRC and CBM. “The vital responsibilities for the physiotherapist during the early days of the adverse situation were: triaging injuries, safe transfers, proper positioning of patients, early mobilisation including bed activities, supply and user training of mobility aids,” said Nishchal Shakya, the NEPTA President.

“We have now realised that this was an opportunity for physiotherapists to prove their value as an integral part in the health system.” The report, The Role of Physical Therapists in Disaster Management, is available for download from the WCPT website.

After the Gig, the IRS – What Independent Contractors Need to Know about Tax Time

 Reprinted from the NYTimes – March 5th Tara S. Bernard.   Read the article for good tax tips, then join our upcoming live webinar April 7th – IC vs. Employee – What You Need to Know 7:30-9:00 EST

Since losing her job in advertising during the financial crisis, Dina Scherer has spent her days helping women cultivate their own personal styles — finding flattering color palettes, editing closets and taking customers on shopping excursions. As a one-woman enterprise, she can be considered a card-carrying member of the so-called gig economy, receiving about half her client leads through Thumbtack, an online marketplace that connects consumers with an array of service providers, whether wedding photographers, music teachers, plumbers or organic cleaning services.

But there’s a reason the gig economy is also known as the 1099 economy, with the number a reference to the tax form issued to independent contractors: Workers in such arrangements are not employees of any company, and the onus is on them to run what are essentially their own businesses, even if the business is simply renting a room through Airbnb or providing rides through Lyft or Uber.  All independent contractors are responsible for handling their own taxes, keeping track of their potentially deductible expenses and familiarizing themselves with the requisite tax forms, all in time to send the forms to the federal government by April 15. (This year, it’s April 18.) “It was intimidating” at first, said Mrs. Scherer, who runs her image and styling agency, Modnitsa Atelier, out of a WeWork shared office space in downtown Manhattan. Now, though, she has her income and expense tracking system down to a science, and consults an accountant come tax season.

There has been a lot of debate about how online platforms have changed the nature of work. In some cases, on-demand companies have been harshly criticized for making employerlike demands on workers but denying them basic benefits and protections. In January, Lyft, the ride-hailing company, settled a lawsuit brought in 2013 by drivers in California who sought to be recognized as full-time employees. Though Lyft agreed to pay $12.25 million, its drivers remained classified as contractors. But the gig economy goes well beyond providing rides on demand. For entrepreneurs, online marketplaces like TaskRabbit, Thumbtack or Etsy have become another avenue to generate leads for their own businesses. Then, there’s the chance for everyone to become a hotelier.

“While more Americans are turning to this kind of gig economy, they do face new and more complicated tax requirements,” said Kathy Pickering, executive director of the Tax Institute at H&R Block.

Where to begin? Here are several requirements the self-employed need to think about, particularly during tax season:

Reporting income Independent contractors who haven’t set up any formal business structure (or who have, as a single-member limited liability company) should report their income through the traditional tax return, Form 1040. They will also typically use a Schedule C, which lists income and expenses, or perhaps a Schedule E, when collecting real estate income.

People running multiple businesses — say, selling photo prints on Etsy while driving for Uber — would need to keep track of all income and expenses separately, using dedicated Schedule C’s for each. There may be state and local tax forms as well. Generally speaking, payments received directly from customers need to be tracked and reported when filing the tax return. But contractors working through a platform like Uber or Lyft, for instance, may be issued a 1099-MISC (which is required when income generated exceeds $600; it is also reported to the I.R.S.). They may also be issued a 1099-K, which tracks income paid through credit- and debit-card payment networks. That all needs to be reported as well.

“One of the most common errors that gets made is people forget or miss reporting all of their income,” Ms. Pickering said. Independent contractors, she said, should track all income on their own, since some may be reported via 1099s and other portions may not. Many on-demand companies send annual earnings reports, too.

Self-employment taxes Employees generally split payroll taxes — which cover Social Security and Medicare and are automatically deducted from paychecks — with their employers.

But independent contractors who generate more than $400 in net profit are responsible for the entire amount, known as self-employment taxes. “No one shares that with you,” said Greg Rosica, a contributing author to the EY Tax Guide 2016.

Expenses and deductions The added taxes may feel burdensome, but self-employment income opens the doors to a host of new deductions, as long as expenses are germane to the business.

“If you are doing things like Uber or a rides program, you can take your gas, your carwash, your vehicle licenses,” Ms. Pickering said. “That may not be obvious for someone getting into this for the first time.”

But there are also several broad categories of expenses that can apply to different businesses. People working out of their homes, for instance, can take the home office deduction, as long as the space is used “regularly and exclusively” for business purposes. If that’s the case, you can deduct $5 a square foot of dedicated office space, up to a maximum of $1,500. Alternatively, a more complicated calculation, based on actual expenses, could yield a greater home office deduction.

Phone lines and computers may also be deductible, separate from the home office expense, but if the time is split between personal and business use, that needs to be documented. “The I.R.S. won’t take your guess,” said Mark Luscombe, principal tax analyst at Wolters Kluwer. “These things should be contemporaneous. They don’t look kindly on you if you create records at the time of the audit.”

Transportation expenses — say, to meet customers — may also be deductible and can be accounted for in a couple of ways: When driving, you can either take the standard mileage deduction or actual expenses to operate the vehicle (lease payments, insurance, gas, oil) based on the ratio of business to personal use. Track both, then take the larger deduction.

Individuals who use their vehicles more than half the time for business may be eligible to deduct up to $25,000 of the cost, as long the vehicle meets certain specifications. “That is a great one for Uber and Lyft drivers, but it also goes for anyone with their own business,” said Lisa Greene-Lewis, a certified public accountant at TurboTax.

Health Insurance As part of the Affordable Care Act, individuals are required to have health insurance, unless they qualify for one of the exemptions. Self-employed people can deduct their health care premiums, as long as they buy the insurance through their business, while contributions to tax-advantaged retirement accounts, like traditional I.R.A.s and SEP I.R.A.s — may also be deductible.

Estimated tax payments Many self-employed people may need to make quarterly estimated tax payments during the tax year if they expect to owe more than $1,000 in federal taxes.

Rental income People who rent part or all of their homes for generally no more than 14 days — say, for just a few lucrative holiday weekends — aren’t required to report the income (and can’t deduct any expenses). But anyone who is renting a space for a longer stretch must generally report that income, along with expenses, on either a Schedule C or Schedule E of the tax return.

There’s quite a bit that can be deducted, items as varied as advertising and cleaning bills, property insurance, repairs and fees paid to agencies like Airbnb.

How much you can claim depends on how many days your home was rented, versus the time it was used personally. If, say, a beach cottage was available for rent all year, even thought it wasn’t rented the entire time, all allowable expenses are deductible. But if it was rented for 85 days and you used it for 15 days, you can typically deduct 85 percent of expenses, according to EY, which wrote a guide on rental property income for Airbnb.

If you’re renting one room in an apartment, one of two methods can be used to calculate how to divide up the expenses: Base the percentage either on the number of rooms in your home or on square footage.

State income taxes and perhaps even local taxes may be owed as well, so be sure to check with those authorities.

Tools Airbnb, Lyft, Uber and others are working with tax and software firms to provide educational materials for their contractors, as well as discounts and tools.

QuickBooks Self-Employed, an accounting program and app, recently introduced a new automatic mileage-tracking feature. And Xero Tax Touch is an app that helps on-demand workers keep track of their incomes and expenses on the go. The information can be transferred to a Schedule C at the end of the year.

Mrs. Scherer, however, uses an old-fashioned spreadsheet, which helps her categorize expenses. It’s all easy to track, since she uses a dedicated credit card and checking account.

But her advice to new contractors? “If you are really fresh and don’t know anything, track everything,” she said. “You’d be surprised what’s deductible.”

Consider this a public service announcement if you work with United Healthcare

November 20 2015:  united healthcare very badFor the last few works I have been consulting with therapists and patients on audits related to United Healthcare. I am sharing this information in the hope that it might save therapists and patients  from going through some of the egregious issues I have seen first hand.

For patients who are insured by United Healthcare- You May Be Entitled to a Refund!!   In accordance with an agreement reached with the Attorney General’s Office, if you were a  patient who received care from an out of network provider who was inaccurately listed by UHC as in network, you can get a refund if you paid the provider more than the copayment or co insurance you were required to pay under your benefit plan, plus 12% interest!!
This applies to all dates of services from January 1 2006 though October 30, 2015.  If you have any questions about this, or how to send in your claims for review, you can contact United HC  directly at 877-276-7342 or you can contact the OAG directly at 800-428-9071 ( in NYS), or 518-776-2480 (out of NYState) or go to  www.ag.ny.gov/bureau/health-care-bureau

Therapists who are in or out of network with United HC – WATCH OUT FOR audits and the “Recovery Services” team of Optum who are aggressively trying to classify therapy services either as medically unnecessary, or retroactively denying payment, and demanding refunds because documentations summited in audits ” did not support” payment or meet their standards.  Here is a link to their policy and procedures on documentation– follow it very very carefully, and I recommend writing all notes  in full sentences, not using any abbreviations and embedding specific time spent on each part of treatment for all timed CPT codes. In my 35 years in the field, I have never seen a more aggressive attempt to classify services that were rendered in the good faith that they would be paid for as “overpayments” with refunds demanded or taken from future payments.