7- FOXcast PT: Jason Falvey at CSM 2018

Jimmy: Welcome to FOXcast, a podcast for clinician’s made by clinician’s. It’s brought to you by FOX Rehabilitation. Find out more at foxrehab.org.

Jimmy: We are live on FOXcast again. I say live and I mean actually live here at Combined Sections Meeting 2018 in New Orleans. And, we are also very much live. I’m pointing at you internet people. You can find us online, our internet streams, or socials @FOXRehab.

I am joined today on FOXcast by Jason Falvey. Jason: Ph.D. candidate and board certified GCS at the University of Colorado Anschutz, research focusing on the demonstrated the value of physical therapy services in post-acute and long term care settings. Jason, welcome to FOXcast.

Jason: Good to see you, Jimmy.

Jimmy: Say hi to everybody out there on the interweb.

Jason: Hello, everybody.

Jimmy: Big, big meeting, the big dance as I like to call it here at CSM. You got about 17,000 your closest friends together. How’s your conference going so far?

Jason: Oh, good. CSM: It’s always a busy time, and the longer you’re here. I think the more stuff that you get asked to do. But, I think it’s really good recharging experience to just come network and see the cool things everybody is up to.

Jimmy: Yeah, it’s fun to see all your friends and then realize you have you don’t have two free minutes to rub together.

So there are so many people you get to have these quick five minute, “You’re going that way. I’m going this way” conversations. “I’ll see you later.” and then maybe sometimes, you do and sometimes you don’t. But, it’s a great reason to  get together.

You said you were just coming from something just a second ago.

Jason: So I was actually coming from Health Policy and Administration platforms. And, we are also reviewing the section grants as well.

So we were going over the scores and some really fantastic research that’s been submitted that’s regarding policy and practice for physical therapists.

Jimmy: You just kind of get a little cheat sheet or you let people know like how to write a good one?

Jason: Yeah, we give people some tips. We give people an idea of how we score them what our algorithms are and the kinds of things we look for.

The quick rundown is: We score the researcher and their experience. We score the research proposal and then score the environment and some of the other factors that would make them successful in being able to do the research. And then, how the money is allocated and how they plan on spending it.

Jimmy: We mentioned before we hit record: You might have really great research and good ideas, but if you’re not writing you grant a certain way, it might not get funded. So let’s make sure you’re writing and communicating that way.

And we know, especially for me – I love that communication is a skill. It’s great that we just say, “Hey, here’s our process here’s our algorithm. Let’s show you how to do it a different way that may be a little better.”

Love that.

Want to talk about PT & aging in place older adults what we’re about here FOX Rehabilitation. What’s that mean to you aging in place?

Jason: So aging in place is not a new concept but it’s something that’s getting a lot more importance nowadays.

One of the ideas of PT that I think we really championed: the idea of how do we keep people at home in an environment that they want to be in. I think if you surveyed most older adults, none of them want to be in a nursing home. It’s not a voluntary setting, especially long-term nursing home institutionalization, and tone-waysually a one way street. Once people go, they very rarely come back out.

So, aging in place has become a quality of life issue but it’s also more recently become a payment and cost issue. So Medicaid, one of the biggest payers of long-term care in the country has undergone a major shift in the last 10 years. And, they have shifted a lot of their institutional care money into community-based, long-term services and those monies are usually relatively unrestricted for certain programs like the program of all-inclusive care for the elderly, which means that those programs can allocate physical therapy as they see fit without caps or limitation.

Jimmy: That’s where we want to be. You know we don’t want to put someone in a situation that we could have prevented them from having to go from a human standpoint. And then you bring in the other thing which which will help leverage getting ideas changed, which is money. Great. It’s something we don’t want to have to do and we can prevent it and save you money in the long term. So I love that. Hospital readmissions that’s something you’re pretty passionate about especially with older adults.

Jason: I think this idea of avoidable hospitalizations is something that PT’s really haven’t been nearly as engaged in as I think is appropriate.

One of the reasons is functional status ability to walk. The ability to do ADLs is one of the strongest predictors of hospitalization and hospital readmission among older adults. Yet, there’s not a whole lot of evidence suggesting what you can do to address it.

So. a lot of research saying, “It’s a biomarker. It’s a risk factor,” and then you just stop researching. And, I want to take that one step further and you need to figure out how to best address disability and frailty in older adults.

And: Does that intervention change the trajectory? Change hospitalization outcomes once they leave the hospital? How much disability they have?

And, more importantly, the trajectory of their recovery, really is prognostic for a long term nursing home admission and hospitalization. Older adults who decline in function are anywhere from three-to-six times more likely to be readmitted to the hospital.

Jimmy: Why do you think that is? That situation where we’ll dance around an issue? We’ll bring up an issue like readmissions and then everybody just keeps going around and around.We all agree. Everybody nods their head. “I agree.” “I agree. This is important.” And then no one studies it  because it’s such a huge problem that we don’t know where to start or why is it?

Jason: I mean, I think most of the attention at the hospital levels are on medical factors, right? So, we know medication reconciliations are very important, right?

There’s a lot of focus on those things in managing chronic conditions. But, what I think is a little bit less obvious: When medical systems and administrators are talking, there’s not a physical therapist in the room. There’s not a physical therapist at the table saying, “How do you transition? How do you get these older adults into programs that will rehabilitate physical function?”

Because, one of the things about physical function is it’s a modifiable risk factor. So polypharmacy might not be, chronic conditions, age, sex, not modifiable physical function is very modifiable. You can measure it readily. It can be modified in a relatively quick timeframe and it might have incredibly protective effects.

Jimmy: Yeah, I love how you point that out so simply. World Health Organization just releasing results from a paper they had done in 2011: Physical activity is the fourth leading cause of disability. And then two of the causes that were above that can be cured or at least improved with physical activity.

So, let’s bring that up: PTs as advocates for older adults.

You mentioned earlier, just a second ago, how we’re not in the room. You need to be in the room. It is going to advocate for our profession and ourselves. But really, us getting in the room, in the conversation, really helps us to be able to advocate for our clients.

When I bring up PTs as advocates, where’s your passion lie?

Jason: I am very, very passionate about the topic we talked about earlier, this long-term care issue and one of the reasons is there’s a major shift in costs. Like, we talked about Affordable Care Act, or Obamacare, really incentivized states to invest money in these community-based resources and states were given free license to design the best programs to keep these people at home.

Yet, we know physical function is one of the biggest predictors in ADL disability and one of the biggest predictors of hospitalization and nursing home institutionalization.

PTs are not in the discussions or part of the program design in Medicaid to really say, “How do we keep this person in their home?” And it’s, some of it’s medical. But, a lot of it is physical and disability related.

“Can we get adaptive equipment in there?”

“Can we put install grab bars?”

“Can we be involved in these innovative housing initiatives that will keep people in their homes safer?”

Fall related fractures will reduce and a lot of those things are better big causes of cost. We could also drive costs down.

Jimmy: Let us get in there and use our eyes to figure out what we can do what we’re best at. We don’t have magic hands, you know. Interventions work because we see read and react. Now, let us get into that conversation and let us show you. We’ll put our money where our mouth is. That’s where payments going anyway. It’s outcomes based. Let us put our money where our mouth is and say, ”Let us get in there and show you how we can improve and then reduce costs, improving function and outcomes and reduce costs.”

Jason: PTs are more than just techs.

PTs can be case managers or take the reins of some of these program design elements that I think are really not our typical role now, especially in Medicaid populations where physical therapy can be very hard to access.

People on primary Medicaid between 55 and 64, it’s very difficult. And, those are the patients who have the most to gain and the most cost savings associated with keeping them at home. If you look at that population, the highest quartile of disability has a very disproportionate share of Medicare and Medicaid costs, independent of how many comorbidities they have. So, people with more disabilities costs Medicare and Medicaid substantially more money, but yet, that’s a modifiable factor for a lot of population health reasons that we’ve discussed.

Jimmy: Well when you put it like that, it sounds so simple. So, I put you in charge of fixing all of that. You’re my guy. You’re my go to.

What else are you looking forward to seeing here at CSM? What are some of the some of the things you’ve got planned?

Jason: COSTAR, the Center on Health Services Research and Training Institute, chaired by Brown and BU and Pitt, is having an event from three to five today are giving a talk on state value. I think that’s going to be fascinating and meeting Linda Reznik and the crew that helps run COSTAR. It’ll be a really a good way for PTs to see how we’re leveraging big data center and get at the table for some of these policy questions.

Jimmy: Those data things are starting to come in. I mean, the companies that have been there for a while and saying they were kind of, “The sky is falling,” and now people are realizing, “Oh no, this data thing is going to be leverage-able and going to directly help all of us, from the top down.”

The last thing we do on the show, here on FOXcast, is we have you tell your FOXtale: Why do you work with older adults? What brought you to work with older adults?

Jason: So that’s a great question and I will say this probably has come up before.

That wasn’t my first intention. I came out of a PT school in rural Maine, ready to work for the Boston Red Sox and realized I couldn’t analyze baseball movements or swings or pitching and I had terrible biomechanics, so I would have to find another avenue looking for a job.

Geriatric neurology kind of popped open as an outpatient job and started doing it and working with Alzheimer’s and Parkinson’s and patients after a stroke. It was a fascinating experience, and the amount of impact you could have on their life with just upping your game based on the usual care standards that these patients often have. It was amazing, and then going into home health and knowing that I kept people in their houses with my intervention’s that might have otherwise ended up in a nursing home or supported them transitioning out of a nursing home was a great experience.

Jimmy: It’s a great reason, and that’s why I keep asking this specific question at the end of every show – because everyone’s got a different tale to tell. It’s all different, but it’s always about people. It’s always about a human, and all brings us back to the same thing: a love that you could always work for.

Like, they have the hero’s day. They bring Red Sox back from five, 10, 15, 20 years after and try to get them ready to jump back in the batter’s box.

Jason: I mean, they probably bring Ted Williams out of his cryogenically frozen state out there, too, if they could. People would cheer.

Jimmy: You’re the first guy they’re calling because you’ll get Ted back to hitting .400. Alright, Jason Falvey on FOXcast, appreciate you taking time at a busy event, as you can hear all around us. Everybody of the 17,000 strong here at the signature event. Thanks for taking time out to talk on FOXcast.

Jason: Great. Thanks, Jimmy.

Jimmy: Thanks for listening to FOXcast, a clinically excellent podcast. It’s brought to you by FOX Rehabilitation listen to other episodes or read articles and position papers at foxrehab.org