Allan Besselink | Physiotherapy | Performance | Prevention | Smart Life Project | Smart Health Revolution

The Disconnect Between Patients, Insurance, Incentives, And Cash

ab@allanbesselink.com (Allan Besselink) — Wed, 22 May 2013 05:04:35 +0000

The phrase "cash-based practice" has become a hot topic and trendy phrase lately. Many physical therapists have headed in this direction. My clinical practice has been cash-based since 2004.

There is a strange perception in health care that third party payment (via insurance) and cash-based practices are inherently different. Perhaps it is because of the perceived "skin in the game" that the patient has when they hand you cash (or a credit card) directly upon receipt of services rendered.

What is forgotten is that no matter how you cut it, both are cash-based. Worse yet, both are built upon a foundation of misguided incentives.

Both sides of this coin are cash-based. The difference is in the degree of transparency involved. On the cash practice side, the consumer can see the direct cash flow from one hand to another. Costs are typically transparent. On the third party payer side, the consumer (or their employer) has already made the cash investment (or part of it) in an insurance plan. The consumer then receives some level of benefits, along with typically paying a copay out of pocket. Costs are rarely transparent, except for the copay.

But either way, they are both cash-based. It is just a question of actually seeing the cash flow, and the transparency of costs involved.

Another disconnect that they both share is one of misguided incentives. As a clinician, even if you attempt to provide the best services at the best cost, there is always an inherent underlying premise that exists: the more visits the patient attends, the more money the clinician makes. No matter how outcome-driven you are as a clinician, there is always that element lurking in the background. If you are working with third party payers, the clinician will oftentimes use whatever visits are available to them given the episode of care and the patient's benefits.

Either way, the incentives are structured poorly. They are built upon procedures and visits and not on outcome or value.

Patients have been lead to believe that cash-based practices are inherently more expensive. In fact, they aren't. Once you calculate time in the office, travel, copay or a percentage pay, and a myriad of factors, it all comes out pretty even. The net dollar value out of pocket may actually be lower.

Once again, we need to compare the world of health care - and the disconnects that exist - to any other consumer market. Most markets, generally speaking, are transparent with costs because consumers demand it. They are based on the receipt of a quality service that meets or exceeds the consumer's expectations. They are all founded upon the consumer's view of quality and value, and not that of the company providing the service.

Don't be fooled though. Within our deeply-flawed health care paradigm, it is all cash-based either way. Consumers just don't demand the same principles in their health care that they do when buying a house. That is the real disconnect.

Note: Ann Wendel (@pranapt on Twitter) and I were recently interviewed by Karen Litzy (@karenlitzyNYC on Twitter) for her radio show "Healthy, Wealthy, And Smart" on the topic of "cash-based practices". You can listen to the interview here.

Photo credits: pwbaker

It’s All About The Patient

ab@allanbesselink.com (Allan Besselink) — Mon, 20 May 2013 05:07:05 +0000

Stop for a moment and reflect on this thought: who is the most important person in health care?

Or another thought, if you are a provider: why are any of us in health care?

It is a simple answer - the patient.

When we speak to the patient about their problem, who is the only one to have the history at their fingertips? The patient.

And when we look at the quality of care, who ultimately has to live with the outcome? The patient.

Once and for all, people, this is all about the patient.

But in our desire to be experts and gurus, we forget that all that we learn comes from the patient.

We decide what is good for them, or safe for them, or who they can access - yet we don't ask the patient what THEY want.

We build grandiose hypotheses around our favorite diagnosis - before taking a thorough history and asking the patient for the details.

We establish goals based on impairments - but refuse to ask the patient what they want to accomplish functionally.

We create outcome measures - that don't measure what is important to the patient.

We talk about creating value - but don't ask the patient just what that looks like.

We talk about cost - but don't make it transparent for the patient.

We do all of these things to make "health care" better - and forget about the one important element in all of it. The patient.

I have found myself inundated at times by statements that reflect a general ignorance of what the patient brings to the health care equation. They ARE the health care equation. Clinicians talk about patients having bias - and yet they fail to realize their own. Legislators talk about keeping patients safe - yet patients are already online searching for their own diagnosis with unfettered access to the Internet.

Frankly, all of this is getting rather old. Because here's a thought: if the patient is the central hub of "patient-centered care" and they don't know, then just who does?

There was a time not so long ago when consumers had problems buying cars. They didn't know what a double overhead cam was, or why fuel injection was or wasn't important. They didn't understand the world of cars. But with time, consumers made themselves, well, better consumers.

The same is true of health and health care. Create an environment in which the patient can be a better consumer. Because, yes, it is all about them.

Guide them. Mentor them. Advocate for them. Listen to them. Let them have choices in their health care. But above all, remember one thing - it's all about the patient.

Photo credits: paul bica

Robin McKenzie 1931 - 2013

ab@allanbesselink.com (Allan Besselink) — Tue, 14 May 2013 05:56:42 +0000

It is with great sadness today that I note the passing of world-renowned physiotherapist Robin McKenzie at the age of 82.

I, like many of my colleagues, have struggled throughout the day. I have found myself challenged to find words to adequately describe what I am feeling right now. There have been tears. And there have been wonderful memories.

I could recount McKenzie's tremendous impact on physiotherapy, musculoskeletal care, and health care as a whole, or his development of the McKenzie Method of Mechanical Diagnosis And Therapy. I am sure that my efforts would be an understatement to his legacy.

But the profound sadness that I feel today is due to the loss of a great man that had a huge impact on who I am as a person.

Robin McKenzie took residence at the intersection of clinician and scientist. He made observations and he tested hypotheses. As he noted, "my patients taught me all I know". It was all about the patient. McKenzie gave the phrase "patient-centered care" true meaning. I took that to heart.

Robin McKenzie was a visionary. He had strength in his convictions and devotion to his principles, even if they were initially not well received by the medical community. His thinking was (and is) at least a few decades ahead of the curve. I always admired his commitment and courage when others doubted him. I took that to heart as well.

My clinical world has been transformed. It started the moment I took my first MDT course in 1994, and continued on through the Diploma program in 1998. It continued through my 9 years as Editor of the US and International McKenzie Journals. The transformation continues to this very moment with each patient that experiences MDT in my office. Throughout those two decades, I have learned about MDT and mechanical loading and clinical reasoning - among many other concepts. For those things alone, I am forever grateful.

But the transformation didn't end with patient care. It was a personal transformation as well. The experiences along the way changed who I am, how I think, and how I see the world around me. This is far more important than directional preference and recovery of function.

The true measure of a man, as they say, is the impact they have on others. I, amongst countless others, can personally attest to Robin McKenzie's impact and inspiration. He has enriched our lives with his passion, his insight, and his sheer presence.

My thoughts and heartfelt condolences go out to his wife Joy, his four children and six grandchildren - along with the "extended family" that is the McKenzie Institute and MDT clinicians around the world.

Thank you, Robin, for being a part of my personal journey. You will be dearly missed.

Scientific Plausibility And Reimbursement

ab@allanbesselink.com (Allan Besselink) — Sun, 12 May 2013 21:58:44 +0000

In the ongoing quest for affordable care, our health care system is in dire need of solutions. If we don't find a way to save some money soon, the system as a whole will implode. Health care will become cost-prohibitive for many - if it isn't already.

We've got to start somewhere. So let's begin with a basic foundational premise: reimbursement based on scientific plausibility.

Did you hear the pin drop in the room? That's because there would be a lot of practitioners that would angrily resist the concept.

Why so? It would demand clinician accountability.

There is a belief throughout health care that a clinician should be entitled to payment for a procedure because they performed it. But just because you perform a procedure - scientifically plausible or otherwise - doesn't mean you are entitled for reimbursement. Third party payers should not be obligated to provide payment for the health care equivalent of snake oil. And there are plenty of variations on this theme currently in existence in health care, all clamoring for their share of the health care reimbursement pie.

I can hear it now ...

"Why should I have to prove what I do?"

It is unethical to provide care when you know it doesn't provide benefit. There is no better way to begin to assess benefit than to hold interventions to the scrutiny of the scientific method. If the approach doesn't have scientific plausibility, then not only should it not be used, but it certainly shouldn't be reimbursed.

I would bet that you would see a significant shift in health care. Basing reimbursement on scientific plausibility would promote a move towards the use of evidence-based strategies. Those that do so would thrive in the marketplace - those that don't, wouldn't (and probably shouldn't anyways).

Here's a thought, third party payers - starting right now, don't pay for scientifically implausible forms of care any longer. If the assessment or treatment doesn't stand up to the rigors of the scientific method at it's most basic level, the level of "could it really take place physiologically" or "is it even plausible in the world of science", then it surely isn't deserving of reimbursement. Simple.

That doesn't mean that a patient can't choose whatever treatment they want. Go right ahead, have whatever type of care you so desire. However, don't expect your insurance company to reimburse for it. As a matter of fact, expect to reimburse the clinician directly out of your own pocket. This would maintain patient choice, but it would also lend the notion that third party reimbursement will and should be science-based to enforce standards of critical thinking and reasoning.

The road to more affordable care could start with payment based on scientific plausibility. Let the insurance companies pay for evidence-based strategies that have a foundation in science. Embrace them and reimburse for them. Voila! Cost savings - and no rocket science necessary.

All it requires are some guts. So, insurance companies, do you have the wherewithal to do something like this? And clinicians, are you ready to base your practice on science and not pseudo-science?

Photo credits: Jeremy Weate

Rhubarb Report 066

ab@allanbesselink.com (Allan Besselink) — Fri, 10 May 2013 05:11:56 +0000

This year is the first time since 2004 that the Toronto Maple Leafs have been a part of the NHL playoffs. They were, until last week, the owners of the league's longest post-season drought. You would also have to go back a lot of years - specifically, to 1967 - to find their last (13th) Stanley Cup win. That gives them the unenviable title of also having the NHL's longest-active championship drought. It's not easy being a Leaf's fan. Trust me on this one.

Just when hopes were high this season, the Leafs have now found themselves in a 3 - 1 deficit against the Boston Bruins. Somehow, this doesn't surprise me from the team that is now the NHL version of the Chicago Cubs. This doesn't qualify as rhubarb as much as it is a painful reality for Leafs fans worldwide.

Reality check aside, and before Leafs depression sets in once again, there is plenty of rhubarb to make you stop and ponder just what makes the world go 'round. Alas, Episode 66 of the Rhubarb Report - game on!

1. The chasm between college and pro sports became readily apparent recently in the world of basketball. On one hand, you have Kobe Bryant tearing his Achilles tendon. It then took him 16 days to return to the Los Angeles Lakers' bench. In the meantime, he could be found critiquing his team from afar - via Twitter. Contrast this with Kevin Ware, the University of Louisville player that sustained a horrific injury in the NCAA Regional Final. Ware underwent surgery and was back on the bench within the week to cheer on his teammates in the Final Four.

I understand the economic differences between the two. But there is much to be said for the attitude (and gratitude) of the player in these scenarios - or lack thereof.

2. In the "are you serious" department, I bring a disturbing statistic to your attention. According to this report, 29% of Americans see a need for an armed revolution in order to protect liberties. That includes 18% of Democrats and 44% of Republicans.

What happened to protecting liberties with a ballot box? My question is - when was the last time that this 29% was actually within a mile of a voting booth?

3. Finally, it is once again time to question the ability of our legislators to govern effectively. Case in point: the recent Senate vote on background checks for firearms purchasers. Senators voted 54 - 46 against the legislation. However, 90% of the country is in favor of mandatory background checks. Disconnect? Lincoln stated in the Gettysburg Address -

"government of the people, by the people, for the people, shall not perish from the earth."

Shouldn't Congress be representing the people of this country? Of course, that assumes one key thing: that legislators are choosing to represent constituents and not political action committees and special interests. Silly me.

Debate the issue of gun control all you want – that isn’t the point. This really isn’t about guns at all. It is an issue of legislators representing constituents - and constituents trusting their elected representatives to do so. The democratic process doesn't work when the relationship is one-sided.

Photo credits: Wikipedia

The Inconvenient Truth About Normal

ab@allanbesselink.com (Allan Besselink) — Wed, 08 May 2013 04:29:55 +0000

Mal-alignment: the scourge of modern day health care practitioners. According to many, it is the root of all clinical evil in the orthopedic world. It has been used to rationalize countless clinical scenarios and treatment interventions.

Rumor has it that resolution of this malady is also the solution to world hunger and peace in the Middle East. But I digress.

Oh, mal-alignment. How you tantalize us with the hypothetical world in which you contribute so much to so many. But understanding you would require a deeper understanding of "normal" first, now wouldn't it?

Which brings us to - the inconvenient truth about normal.

So just what is "normal"? On one side of that normal distribution, you have patients that are asymptomatic and have horrible alignment and/or symmetry; on the other side, you have patients that are symptomatic and have great alignment and/or symmetry. And then you have the vast majority in the middle, those considered "normal".

Reid (1992) noted that “mal-alignment is a term that should be reserved for gross abnormalities, two standard deviations outside the norm”. Statistically speaking, that doesn't leave a large percentage of the population that are "abnormal".

This line of reasoning regarding normal extends into imaging studies. Take, for example, the lumbar spine. There will be 70% of asymptomatic lumbar spines that have an abnormal MRI. Depending on the study, 50 - 90% of asymptomatic shoulders have a partial thickness tear of the rotator cuff on MRI. Knee MRI? Chances are good you are painfree and fully functional yet have a meniscal tear on MRI. Similar issues exist with radiography. People can have osteoarthritic joints that are painfree, and pristine joints that have pain. And all points in between.

Welcome to the majority. Welcome to normal.

Perhaps most importantly, having a positive MRI or significant mal-alignment doesn't necessarily tell me much about your presenting problem, your lack of function, or your future. It needs context.

Can there be some scientific plausibility to a relationship between mal-alignment and the onset of symptoms? Yes. A great example is the acute lateral shift that can occur with an episode of low back pain. The patient reports being "straight", then is suddenly shifted with the onset of their symptoms and loss of function. There is a mechanical cause-and-effect relationship in time and space. There is relevance and context. The patient can relate the onset of symptoms to changes in their "normal" alignment and function - whatever that is.

But in most clinical situations, clinicians make a quantum leap in thinking by relating mal-alignment and asymmetry to the onset of symptoms and loss of function. This is a problem of thinking more so than a lack of relationship between variables.

Clinicians embrace mal-alignments and asymmetries because they promote endless hypotheses that can rationalize just about any treatment intervention. Mal-alignments and asymmetries have the potential to create countless treatment sessions while trying to make the patient “normal”. Those "treatment" interventions could, in fact, be addressing something that is already normal for that patient. Unfortunately, this line of clinical reasoning leaves us with a bit of a conundrum. No, let me rephrase that - a logical fallacy.

So what do we do now? Do we maintain the contradiction in our thinking? Or do we change our paradigm?

Health care providers as a whole can choose - right now - to let go of the belief. They can eradicate these logical fallacies. But in doing so, there will be a significant degree of discomfort in doing so. You can either fight the emotions, maintain the contradiction, and defend your stance - or you can acknowledge the reasoning, integrate it into a better scientific methodology, and move forward.

Which one do you choose? And which one is best for the patient?

Photo credits: skpy

HB 1039 Out Of Public Health Committee - But It Needs Your Voice

ab@allanbesselink.com (Allan Besselink) — Mon, 06 May 2013 05:22:22 +0000

On Tuesday, April 30, the House Public Health Committee finally voted on HB 1039, a bill that would improve patient access to physical therapy in the state of Texas. The committee voted 6 - 3 to pass the bill favorably out of committee.

Now it is on its way to the Calendars Committee who are responsible for putting it on the House calendar for second and third reading. This must occur before it gets a vote on the House floor.

As exciting as this sounds - and it is - time is running out. This is where you, the consumer, can help decide the future of health care in the state of Texas.

The journey of HB 1039 this session brought it to a public hearing on April 10, 2013. At this time, 14 provided testimony in support of the bill (including myself) with 3 against the bill. The video can be viewed here (starts around 9:25 am) and here (starts around 12:45 pm). After about 2 hours of testimony, the public hearing for this bill concluded. It was left pending in committee, awaiting a vote, for the next 20 days. After being reported favorably out of committee, it was sent to the Calendars Committee on May 2, 2013.

The Texas Legislature meets for 140 days every two years. All House bills must be passed out of the House by May 9. This leaves just a couple of days for the Calendars Committee to place the bill on the House calendar for a second and third reading.

It is a tight schedule. But it can be done. It will require the voices of many. And they will need to act now.

The members of the Calendars Committee are listed below. If you are one of their constituents, please contact them and ask them to put HB 1039 on the House calendar as soon as possible this week.

Rep. Todd Hunter (Chair)

Rep. Eddie Lucio III (Vice Chair)

Rep. Roberto R. Alonzo

Rep. Carol Alvarado

Rep. Dan Branch

Rep. Angie Chen Button

Rep. Byron Cook

Rep. Myra Crownover

Rep. Sarah Davis

Rep. John Frullo

Rep. Charlie Geren

Rep. Helen Giddings

Rep. John Kuempel

Rep. Doug Miller

Let your representative know the importance of the bill in providing patients with not only improved access to care but decreased cost of care as well. This is a bill with bipartisan support.

Now is the time for change in Texas. Your voice CAN make a difference. Let's get HB 1039 to the House floor so that ALL of the people of Texas and their legislators can decide.

It's your health care. Don't you deserve the right to choose?

Photo credits: abesselink

The Tragedies Among Us

ab@allanbesselink.com (Allan Besselink) — Fri, 03 May 2013 03:31:11 +0000

Last month was a tough month. The events of Boston, Massachusetts and West, Texas brought tragedy front and center in our world once again.

The news of the Boston bombings was everywhere you looked. Many were exposed to the devastation that struck the community of West. We are in a world these days in which the more sensational or shocking the news is, the more tragic the event is perceived. It could be Boston or West or Newtown or Columbine or Oklahoma City. You don't have to go overseas to find examples. Just look in our own backyard.

Throughout that fateful week, the overwhelming thought wasn't one of making sense of the evil, the pain, or the suffering. My mind kept coming back to our responses to the tragedies among us.

The events of the week remind us of the power of community and the beauty of liberty and freedom in this country. They remind us that we can come together when the chips are down to work towards a common goal. We can reach out to one another. We can ask "are you ok"? We can put our hearts and heads and hands together and get back on our feet. We can help each other. Inspirational, indeed.

"Tragedy is a tool for the living to gain wisdom, not a guide by which to live." (Robert Kennedy)

But when it comes to tragedy, the harsh reality is this: we all have some degree of personal tragedy in our daily lives, be it within ourselves or our friends and family. It could be a friend with cancer, or the passing of one's grandmother or child, or the collapse of our fiscal dreams, or an internal struggle with loneliness or depression. Most of what we experience isn't on the evening news. And even if it is, chances are good it will be short-lived, a mere blip on the media screen. That doesn't make it any less powerful or gut-wrenching or tragic. Most of this gets internalized unless we are fortunate enough to have a good support network, something that many simply don't have.

What saddens me most is that these powerful actions of humanity - of individuals and communities - shouldn't just make an appearance when there is a newsworthy or horrific event. Nor should we turn a blind eye to them once tragedy leaves - because it never leaves. It just becomes less newsworthy. Pain and suffering - oftentimes silent - is amongst us on a daily basis, not just when explosions strike or shots are fired.

The power of community is something that requires nurturing and building on a regular basis. Frankly, we could do with a healthy dose of "coming together" on a daily basis - as a community, and as individuals. But it is easily forgotten when tragedy isn't in your face anymore. And I will be the first to admit, it is easy to lose sight of these things.

Imagine for a moment what your world would be like if you had the strength, courage, fortitude and love of a Boston or West surrounding you every day - when times were good, and times were not so good. I suspect we would all be better for it - tragedy or otherwise.

Photo credits: UCFFool

Five Mental Strategies To Improve Your Training - And Change Your Life

ab@allanbesselink.com (Allan Besselink) — Wed, 01 May 2013 04:13:41 +0000

Pick up any book on training for virtually any sport. Crack it open and review the contents. I have no doubt that you will find it filled with copious content on the physical elements of training. Everyone likes to discuss how to build the physical capacity of sport performance. Workouts are king.

What we need to remember, however, is that the brain and central nervous system control everything. The brain can be trained - just like the rest of the body. Cognitive strategies will have an impact not only on the central nervous system, but the endocrine and immune systems as well.

So without any further adieu, here are five mental strategies that can help optimize your training, improve your racing, and yes, change your life.

1. Remember "the big picture". As Stephen Covey once noted, “Begin with the end in mind”. Always focus on what is important in the “big picture”. This starts with having a broad overview of your training plan and how it fits into the context of your life. This is important if you are a recreational athlete or an elite athlete. Our lives are defined by much more than the training miles we do. Recovery time assists in physical adaptation along with time to balance other joys and responsibilities in life. Mentally, this eases the challenge of training by establishing a better overall balance.

2. Develop a “Zen” mind. Training (and life) is a journey and not a destination. After completing a workout, it should not be thought of with the superlatives of "good" or "bad", but rather "it is what it is". One workout typically isn't a make-or-break issue. Acknowledge it, learn from it, and set your sights on ways to improve it next time. Training provides tremendous life lessons as we have the opportunity to learn more about ourselves in the process. Be open to the experience and develop an inner awareness.

3. Improve your self talk. Our perceived reality is based on what we say to ourselves - which is often negative. Self-image can be a very significant self-limiter and can be reflected in issues such as “fear of failure” and “fear of success”. Negative self talk and self image can lead to self-destructive behaviors that can be manifested in your training. Acknowledge these behaviors and be vigilant about addressing them - in sport AND life.

4. Build attentional focus. There are two primary techniques that should be considered with respect to attentional focus – associative and dissociative techniques. Associative techniques seek to focus attention on aspects of the current performance that resemble the thoughts/feelings related to a previous good performance or experience. Dissociative techniques seek to draw attention away from the current aspects that may be negative, such as discomfort or race conditions. Develop the ability to maintain focus on the task at hand.

5. Develop visualization and imagery skills. This involves creating a “movie in your mind”, being able to visualize an event or a training session “the way it is supposed to be”. Go through the event or training session in your mind beforehand. Imagine it in as much detail as possible. Make the images vivid. This can actually facilitate the appropriate patterns of motor recruitment. You've seen it before - now go do it!

With these five mental strategies, you can build a cognitive foundation for optimal training and recovery and better race performances. Better yet, they translate nicely to successful life strategies.

Do you do any sort of mental training as part of your current training or racing plan? If so, what strategies have worked best for you?

Photo credits: JD Hancock

Rush And The Essay That Changed My Life

ab@allanbesselink.com (Allan Besselink) — Mon, 29 Apr 2013 04:30:40 +0000

Rush arrived at the Frank Erwin Center on Tuesday night for the start of their latest tour, just 5 days after being inducted into the Rock and Roll Hall of Fame. What ended up as a phenomenal 2.5 hour performance started with a song from 1982 called "Subdivisions". It immediately took me back to a place many years ago: January, 1984.

I will admit, those were difficult times, struggling as many do with trying to find your place in the world. While my friends gravitated towards the hollow mind candy of Top 40 hits, I found myself immersed in musicians like Jimi Hendrix and, yes, Rush. I saw the world a little differently than most of my friends, and it certainly wasn't without it's share of friction.

Meanwhile, there was this class called "Canadian literature" that I had to survive. Little did I know that it would change my world and forever alter the course of my life.

There's just one problem with Canadian literature. All of the required readings represented what I would have considered (at the time) as the sum total of anything remotely notable in the genre. So when you are then asked to write two reports on books that aren't a part of the curriculum, you have your hands full. This becomes even more problematic when you aren't really much of a writer in the first place. I was a math and science guy, and definitely not a writer.

Welcome to my literary angst.

Fortunately, my English teacher, Mr. Heuther, opened up the assignment and gave us an option. We could select a Canadian musician or band, choose a number of their songs, and do a review and analysis of their lyrics - instead of a Canadian author.

There was hope.

Rush saved me.

I dove headlong into their lyrics, the thoughtful and insightful musings of Neil Peart. I explored themes that had meaning to me. And, imagine this: it was my highest grade in that class all semester. It is the one piece of writing from high school that I filed away. I have it to this day.

There was far greater value to that essay than the grade I received. Until that point in time, I had not really thought that exploring and reflecting upon what was inside me was important or relevant. That changed quickly. I learned to value the process of self-reflection, to try and make sense of it, and then get it onto the page in front of me. I realized at that time that maybe I could write.

When I look back on my journey as a writer and as a human being, I harken back to what I learned about myself during that period. Much of that can be attributed to the themes buried in that one essay. It was alright to be an individual, to be a dreamer, to not necessarily fit. You didn't have to conform. You didn't have to be cool. It gave me strength to examine the world within me when others doubted me and life challenged me.

So you can imagine my thoughts, some 29 years after writing that paper, when Tuesday's concert started with "Subdivisions". I thought back to 1984, and I smiled. I got a little choked up. And I gave thanks to Neil, Alex, and Geddy. Little did you know the impact you had on one man's world so many years ago - and I am much better now because of it.

Photo credits: ceedub13

Allan Besselink | Physiotherapy | Performance | Prevention | Smart Life Project | Smart Health Revolution

The Disconnect Between Patients, Insurance, Incentives, And Cash

Related Articles By Allan Besselink

It’s All About The Patient

Related Articles By Allan Besselink

Robin McKenzie 1931 - 2013

Related Articles By Allan Besselink

Scientific Plausibility And Reimbursement

Related Articles By Allan Besselink

Rhubarb Report 066

Related Articles By Allan Besselink

The Inconvenient Truth About Normal

Related Articles By Allan Besselink

HB 1039 Out Of Public Health Committee - But It Needs Your Voice

Related Articles By Allan Besselink

The Tragedies Among Us

Related Articles By Allan Besselink

Five Mental Strategies To Improve Your Training - And Change Your Life

Rush And The Essay That Changed My Life