(Transcript created by Riverside AI)

Dana (00:15) Welcome back everybody to episode five of the Future Proof PT. I'm here with my co-host Alex Bendersky and we are going to talk to you today about

the rules and roles in value-based care for musculoskeletal care. So that as the focus. And Alex has done some really good thinking about this. I thought a great way to start would just let Alex talk a little bit about this concept of the rules and the roles and what that means. And we're going to take it from there like we do in our conversational style here on our podcast.

Alex (00:50) Absolutely. And thank you, Dana. And it is a pleasure to be here for another episode. It is a wonderful, warm Sunday in Chicago. So what better way than to spend it with you to discuss these topics. like rules and rules and digging into that stoic philosophy of finding your fit in life and in the pursuit of your personal virtues, right?

I think it's a perfect duality to summarize us as professionals, us as both thinkers, but also doers in a healthcare model. And so there are rules that shape us who we are, and then there are rules that highlight what we can do and how we can deliver. And so in a essence of the clinical function, the rules that govern

our execution of clinical care is our ability to adhere to best practices, ability to adhere to evidence-based practice, ability to provide the concordant care. And then there's a regulatory framework. There's rules that govern how we can execute clinical care based on regulation. There's obviously the Medicare rules. There are commercial payer rules. There are state regulated rules that...

provide variable degrees of autonomy. And then there is a framework where the clinic may have a function to limit your ability to provide care past a certain threshold. These are all framework rules that are imposed to us as we deliver care. And then there's of course value-based rules, which I think value being anchored to a specific parameter that we have to embrace. So the rules that govern value are...

executed as you're referencing. there's the quality rules, there is the impact factors, there is a cost over outcome specific rules that create this specific parameter. And then there are rules, our clinical rules as a clinician, as a medical or physical therapy or allied health scientist, as a custodian of human knowledge that applies to specific factors. So as a physical therapist, you're a custodian of your

knowledge and expertise that is related to musculoskeletal care. As a physician, are custodian of your expertise that is related to your specific medical field. There is a specific function of rules that has to do with support personnel, which is these are the custodians of our ability to deliver care. So we will look into the clinical care only from the framework of clinicians. We're being blinded about the entire network, the entire village of humans.

that help us do what we do, right? So the position that helps support our role by providing their role into this function. And then there's, of course, the role of a larger healthcare system as it applies, like which role shifts and transitions based on a situation. And as we were just having discussion before we went live,

Your role as a clinician may be very different when you're applying clinical care services in a rural segment of United States, where you almost have to be this primary care individual, even as a physical therapist. You are providing a lot of ancillary health services because you are maybe the only clinician in a hundred mile radius. And then the same role is very different when you are a high level specialist in a multi-segmented clinic where you have a specific role.

you are a Mackenzie specialist. So you are being entrenched a little bit into one specific area of expertise where your role is to provide and deliver high-level care to a specific diagnosis at a specific time through a specific network of modalities. So I think the key, the connection here is that actualization of personal virtues as a professional when rules are compounded by roles. And so think of this network geolinked together.

making us who we are. I think definitely looking forward to having this discussion about rules and roles and how it applies to both value-based care but also a profession and beyond.

Dana (04:45) Love it and it's kind of going down a little bit of philosophical path here. one first question for you Alex is what do you see as the difference between the role we play when we're delivering transactional fee-for-service care and

The goal is to optimize, maximize the number of billable units versus pure value-based care where the marker of success and financial success even for either ourselves or our employer is the best outcome supporting the best longitudinal care for patients, not just

within the care that we're providing but along the entire year that an individual is being managed Where is that shift that I think therapists if we're thinking about value-based care as the next thing we need to be able to be successful in? What should therapists be thinking about as different role that they have to play?

And maybe what's the same? where are going to be those friction points? What might be challenges for therapists in moving to this different type of model of care? If you could opine on that a little bit, I would really be interested in your thoughts

Alex (05:59) Yeah, I think that it's an important subject to dig into. And one is that marker of success. How objective is that marker? Who is aligning this marker and who is structuring this marker? So there's a lot of arbitrary or non-objective markers of success that are involved in a traditional care delivery, which have to do more with volume.

or frequency of these episodes of care that they can be provided. And so transitioning your self-imposed marker of success from being more of a care delivery system, which you are a product because you deliver care. So essentially healthcare is a service-based industry. a foundation of the traditional fee-for-service model is you are the assembly line and the more...

the more service you could put out there, the more valuable you are to your employer, to your organization, And I think that is an antiquated way of looking at a care delivery model because as we transition to value-based care, your knowledge, your experience and expertise, and think of those as three factors, right? Your ability to acquire.