Guest guest Posted December 19, 2011 Report Share Posted December 19, 2011 [image: Posterous Spaces] [image: Your daily Update] December 19th, 2011 Will Your College Survive? | TechCrunch<http://ptmanagerblog.com/will-your-college-survive-techcrunch> Posted about 20 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=87257542> Will Your College Survive? Katzman *Editor’s note: Guest contributor Katzman<http://www.crunchbase.com/person/john-katzman>is the founder and CEO of 2tor <http://2tor.com/>, an education startup that partners with universities to deliver selective degree programs online to students across the world. Katzman also founded the Princeton Review where he served as president and CEO from 1981-2007.* The Internet will save higher education, but it may kill your alma mater Thiel believes<http://techcrunch.com/2011/04/10/peter-thiel-were-in-a-bubble-and-its-n\ ot-the-internet-its-higher-education/>smart people don’t need college, and he’s right: There have always been autodidacts who can learn without assistance. Of course, we don’t really need supermarkets and restaurants either; we could all grow and cook our own food. Yet having professionals help us has always been a cost-benefit decision. What are the costs of a great education, including the opportunity cost of four years of work, and how do these costs balance against the impact of that education on your life? The Internet is the first technology since the printing press, which could lower the cost of a great education and, in doing so, make that cost-benefit analysis much easier for most students. It could allow American schools to service twice as many students as they do now, and in ways that are both effective and cost-effective. For reasons that will be outlined below, however, it will probably end up doing this with half as many schools. And your school, even if it’s bumper-sticker worthy, might not make the cut. *Rising Costs* College tuitions have risen 2-4 points over inflation each year since World War II; we stand on the brink of the $250,000 undergraduate education. The rising cost of college was predictable: Bowen, who later became President of Princeton, first put some math to this in 1966. The problem is not the cost of football teams or palatial dorms; it’s a lack of productivity growth. Putting a professor in a room with 25 students cannot become more efficient every year, while almost everything else in society does. The ability to offer an online program of equal quality to its classroom peers can make education somewhat less expensive and, by letting universities continue to improve productivity at the same rate as other parts of the economy, allow them to hold tuition increases flat to inflation. (Note: Some people argue they can give a perfectly good college course for nothing or for $100 per course; these are simply correspondence courses on steroids, more helpful to those autodidacts than the rest of us. Any college that can be replaced by those programs should be.) Good distance learning solves other problems as well. There are many more students in the world qualified and able to go to a great American university than spots at those schools. Rather than building billion-dollar campuses in the United Arab Emirates, a school can inexpensively turn the entire globe into its campus. *Investment & Scale** * The Internet rewards scale; by trading higher up-front costs for lower marginal cost, market leaders can invest in better technology and service. As a result, there is nothing online that is both great in quality and small in scale. Amazon wasn’t originally a better bookstore than the small shops we mourn, but it is now. This is why the Net tends to consolidate markets. As we’ve seen with booksellers and travel agencies, industry winners can invest more in great technology and build on their large networks; losers have neither the quality nor the community to keep up. Traditionally, universities have seen size as potentially dilutive to quality. If you doubled the size of campus and faculty, most would argue that you would make it a less compelling school. However, online schools will be as good as their classroom peers *only* if they are large enough to afford a substantial and ongoing investment. Of the universities who launch online programs, a few will thoughtfully navigate the quality/size cycle. They will invest heavily in quality, using great technology, millions of dollars of content and student support. That quality, in turn, will make them popular within their target community (e.g. adult learners, high-achieving students). Finally, that popularity will give them the resources to further improve their programs, enticing more and more qualified students. Again, a high-quality online education is not free—there are no magic bullets here—but that technology and scale will help turn the tide on costs. As online courses and programs become a larger percentage of these schools, their tuition increases will moderate and eventually reverse. Since there is a finite supply of qualified students, however, other schools will end up suffering. Their costs and tuitions will continue to rise more than inflation, putting them at an increasing competitive disadvantage. More and more of their students will find it compelling to study online, and the larger programs will have more advanced technology and global communities. Even their faculties may be drawn away by the reach and research budget of their hybrid peers. These will all be contributing factors to a consolidation in higher education, a process that will mirror the way the Net has disrupted other parts of society, like bookstores and travel agencies. Every year, schools that are scraping by right now will find the world a little harder. The smartest will merge into other schools; the others will go bankrupt in the time-honored way: very slowly, and then very quickly. *Winning Your Tier** * Some might imagine that in this consolidation, the top schools will win and the less prestigious schools will lose. Not so. Universities and bookstores compete differently. Schools are more specialized—engineering schools don’t compete with music schools, for instance—and they are of varying levels of selectivity. Since much of a school’s value comes from the interaction among students and between students and faculty, universities both recruit and are attractive to students of similar academic backgrounds. Harvard, in other words, does not compete for students with Devry. The likely winnowing, then, will happen *within* each tier of university. Instead of competing for students on a regional basis, online schools targeting adult learners compete on a national basis; so will the elite schools or the schools focused on any particular academic discipline. And within each tier, only the schools that properly navigate the quality/size cycle will survive the shakeout. Within the elite tier, a few others will have a second chance. Due to their endowment and general excellence, most Ivy League schools might become less central to the global education world, but still be islands of research and learning. Within other groupings of universities, though, the new competition will be less forgiving. As states continue to lower subsidies, and as schools with similar reputations step up their competition, this could be a difficult decade for many colleges. *Evolve or Else* Like any other disruptive transition, the move to online and blended universities will bring tremendous benefit to students—better education in more places at lower tuition. However, these changes will be painful for many schools. Most bookstores and travel agencies found themselves on the wrong side of a steadily growing force; the schools that thrive over the next two decades will do so only because they have carefully harnessed that very same force: the Internet. via techcrunch.com<http://techcrunch.com/2011/12/18/will-your-college-survive/?utm_s\ ource=feedburner & utm_medium=feed & utm_campaign=Feed%3A+Techcrunch+%28TechCrunch%2\ 9> MRI No Help in Treating Lower Back Pain with Steroid Injections - Diagnostic Imaging<http://ptmanagerblog.com/mri-no-help-in-treating-lower-back-pain-with> Posted about 20 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=87257872> MRI No Help in Treating Lower Back Pain with Steroid Injections By Diagnostic Imaging Staff | December 13, 2011 ------------------------------ Magnetic resonance imaging does not appear to help patients slated for epidural steroid injections (ESI) for chronic lower back pain, and has only a minor effect on the physician’s decision making, according to a study<http://archinte.ama-assn.org/cgi/content/full/archinternmed.2011.593>publi\ shed online this week by the *Archives of Internal Medicine.* Lower back pain is the world’s leading cause of disability, and one of the top three reasons people seek medical attention, according to the report by a team led by P. Cohen, MD, of The s Hopkins School of Medicine. Despite several studies demonstrating that advanced radiology does not improve outcomes in patients with lower back pain — with or without symptoms such as nerve irritation causing pain shooting down the back of the leg — the use of MRI <http://www.diagnosticimaging.com/mri> in this context continues to soar, Cohen and colleagues wrote. “The lack of unequivocal guidelines on the use of MRI before ESI is somewhat unexpected, considering that ESI is the most frequently performed procedure in pain clinics throughout the United States,” they wrote. The team conducted a multicenter randomized study in which the treating physician in group 1 patients was blinded to the MRI results, while the physician for group 2 patients decided on the treatment after reviewing the MRI findings. For the patients in group 1, an independent physician proposed a treatment plan after reviewing the MRI, and that plan was compared to the treatment the patient actually received. A total of 132 patients (average age 52, of whom 34 percent were taking painkillers) were randomized into the two groups. Group 1 patients all received ESIs. Not all patients in group 2 received ESIs, if the MRI finding did not support that treatment, at which point the patients exited the study. A month later, group 2 had slightly lower pain scores than the MRI-blinded patients in group 1. But the differences had evaporated at three months, the researchers reported. “In conclusion,” the authors wrote, “our results suggest that although MRI may have a minor effect on decision making, it is unlikely to avert a procedure, diminish complications, or improve outcomes. Considering how frequently ESIs are performed, not routinely ordering an MRI before a lumbosacral ESI may save significant time and resources.” via diagnosticimaging.com<http://www.diagnosticimaging.com/mri/content/article/11361\ 9/2005420> Doctors’ financial ties may lead to needless MRIs - Boston.com<http://ptmanagerblog.com/doctors-financial-ties-may-lead-to-needless-\ m> Posted about 19 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=87260683> Doctors’ financial ties may lead to needless MRIs November 30, 2011|Lindsey Tanner, AP Medical Writer here may be good reason to ask about financial ties if your doctor orders an expensive imaging test for your aching back: Patients whose physicians own the equipment are more likely to get scans they might not need than those whose doctors have no financial interest, a small study suggests. Researchers analyzed reports on 500 MRI scans performed on patients with lower back pain that had been sent for review to Duke University. Of the scans with normal results, 106 were ordered by orthopedic surgeons who owned the machines versus 57 by doctors without financial ties. The normal scans accounted for about half of those ordered by surgeons with financial connections, compared with about a quarter in the other group. The authors only examined the scans, so there’s no information on the patients’ medical history or outcome. But the results suggest that some doctors who own MRI scanners use them excessively on patients who probably don’t need them, to help pay for the expensive equipment and make a profit, said study co-author Dr. Ramsey Kilani, a radiology instructor at Duke University. “Once you own a scanner, you have an incentive to run it 24 hours a day,’’ Kilani said. The study isn’t the first to suggest that overtreatment is a risk when doctors have a financial stake in medical care they order, and others have questioned the usefulness of imaging tests for back pain, but the research “helps to quantify the degree of overutilization,’’ Kilani said. Medicare bars that kind of financial relationship but there’s an exemption for in-office medical scanners versus off-site machines, Kilani said. Kilani declined to identify the city or the two orthopedic offices involved in the study, citing research confidentiality agreements, but said similar results likely would be found in other cities. The study was presented at this week’s Radiological Society of North America meeting in Chicago. MRI scanning equipment generally costs more than $1 million. A scan of the lower back can cost patients close to $2,000, and Kilani said doctors who own the machines receive a fee that can total more than $1,000 per scan. The study involved adults who had MRI scans to search for causes of lower back pain. The researchers reviewed results of 250 scans ordered during a recent six-month period by orthopedic surgeons who owned MRI scanners and 250 scans ordered by surgeons who had no financial stake. About one-third of the scans studied showed no abnormalities — 106 were ordered by doctors with financial ties, versus 57 ordered by the other group. Patients in the group without financial ties were slightly older — 57 on average versus 50, which could partly explain why that group had more abnormal results. via articles.boston.com<http://articles.boston.com/2011-11-30/lifestyle/30459741_1_s\ cans-patients-financial-ties> A Harvard Doctor’s Startup Trains Hospitals to Rehab Cancer Survivors - Bloomberg<http://ptmanagerblog.com/a-harvard-doctors-startup-trains-hospitals-to\ > Posted about 19 hours ago by [image: _portrait_thumb] Kovacek, PT, DPT, MSA <http://posterous.com/users/1l1oCkDWEWjv> to PTManager<http://ptmanagerblog.com> [image: Like this post]<http://posterous.com/likes/create?post_id=87261518> A Harvard Doctor’s Startup Trains Hospitals to Rehab Cancer Survivors <http://www.bloomberg.com/news/2011-12-16/a-harvard-doctor-s-startup-trains-hosp\ itals-to-rehab-cancer-survivors.html/> Q By Tozzi - Dec 16, 2011 4:30 PM ET Fri Dec 16 21:30:37 GMT 2011 Dr. Silver, a breast cancer survivor, and Diane Stokes started a company to tailor rehabilitation to cancer patients. Dr. Silver, a breast cancer survivor, and Diane Stokes started a company to tailor rehabilitation to cancer patients. Photographer: ph Sywenkyj/Bloomberg Wade, a Florida social worker, was diagnosed with an incurable form of breast cancer <http://topics.bloomberg.com/breast-cancer/> a decade ago. Two surgeries and years of chemotherapy left Wade, 61, with a damaged heart, chronic swelling in her left arm, spinal arthritis, nerve damage and fatigue, among other problems. “They didn’t send me home well,” she says. “They sent me home sicker than I began.” Survivors of strokes, heart attacks and traumatic injuries routinely get rehabilitation to improve their strength, energy and functioning. For cancer patients, it’s a rarity. It wasn’t always this way. “We used to have better cancer rehabilitation than we do now,” says Dr. Alfano, a program director at the Office of Cancer Survivorship at the National Cancer Institute <http://topics.bloomberg.com/national-cancer-institute/>. Before the 1980s, when most cancer treatment involved long hospital stays, survivors would get rehab before being discharged. As treatments improved and outpatient care became more common, Alfano says, “those programs kind of disappeared to a large extent.” Now the medical world is recognizing that the 12 million cancer survivors in the U.S. can benefit from more comprehensive rehab. Six years ago the Institute of Medicine <http://topics.bloomberg.com/institute-of-medicine/> called for giving every survivor a “care plan” to manage the lasting consequences of treatment, and this year the American College of Surgeons made such post-treatment attention to quality of life a requirement for its 1,500 accredited hospitals. Dr. Silver, a Harvard Medical School rehab physician who survived breast cancer herself, is one of the pioneers trying to make rehabilitation a standard part of cancer care. Silver co-founded Oncology Rehab Partners in 2009 to help hospitals and rehab centers tailor rehab programs to cancer patients. “There’s rehab for everything,” she says, “except cancer.” Silver and her business partner Diane Stokes developed a program to certify cancer rehab that has been adopted by dozens of institutions, including s Hopkins Hospital, over the past two years. The Survivorship Training and Rehab program, or STAR, offers online training to oncologists, primary care doctors, nurses, therapists and other practitioners, as well as nonmedical staff such as social workers and administrators. In October, several hospitals and rehab clinics in Rhode Island <http://topics.bloomberg.com/rhode-island/> jointly got certified in the STAR program in an effort to make its certified rehab available across the state. The STAR program’s goal is to teach doctors how rehab can help cancer patients and to teach rehab professionals about the unique needs of cancer survivors. After training, Oncology Rehab Partners helps health care providers create systems for referring, evaluating and rehabilitating cancer survivors. Today, many doctors send cancer patients to fitness classes, yoga or massage therapists to soothe the effects of treatment. Unlike rehab, such nonmedical care isn’t generally covered by insurance. Silver says many survivors need more customized help, including physical, occupational and speech therapy, to regain their abilities and transition back into work and family life. For example, many survivors of head and neck cancers stop driving because they have difficulty turning their heads. Physical therapy can improve their neck motion, allowing them to drive again and, often, to go back to work. Others may have trouble speaking or swallowing that speech therapy can relieve. Oncologists may not recognize their needs, however. “People are told this is your new normal, accept this,” Silver says, “when in fact that may not be their new normal if they had appropriate rehabilitation services.” Institutions pay $10,000 to $44,000 for certification. (Individuals, such as solo physical therapists, can also get certified for $2,000.) Over time, Oncology Rehab Partners will measure the programs’ success by looking at patient satisfaction and improvements as part of a recertification process that will cost $5,000 to $10,000. The seven-employee company, based in Northborough, Mass., expects revenue of more than $2 million in 2012, up from about $500,000 this year, says Stokes. Physical therapist Sherry Spencer Brown was part of a 15-person team that brought the STAR program to Hawthorn Medical Associates, a 75-doctor practice in North Dartmouth, Mass. The training helped Brown learn more about the consequences of chemo and radiation, while her colleagues in Hawthorn’s cancer center learned how rehab could help survivors recover after treatment. “We all came from a different perspective and different clinical strengths and got to learn about other areas that we’re not as well-versed in,” says Brown. Silver developed the STAR program after her own breast cancer treatment in 2003 left her too weak to go back to work. She got her strength back over two years, drawing on her own expertise as a rehab physician and working with a personal trainer. The experience awakened her to the problem many cancer survivors face: After debilitating treatment, they have no road back to anything like the life they knew before being diagnosed. The health system “literally drops people off as medical refugees to navigate this labyrinth on their own,” says Kirch, director of quality of life and survivorship at the American Cancer Society<http://topics.bloomberg.com/american-cancer-society/>. Doctors are so focused on curing the disease that patients’ pain and the effects of chemo and other treatments take a back seat. “There’s very little training in medical school and beyond that addresses the symptoms, the side effects, the late effects [that can manifest years after treatment] and the rehabilitation needs,” she says. Even at top-rated cancer centers, comprehensive rehab is a relatively new focus. At Memorial Sloan-Kettering Cancer Center<http://topics.bloomberg.com/memorial-sloan--kettering-cancer-center/>in New York <http://topics.bloomberg.com/new-york/>, rehabilitation until 10 years ago largely centered around lymphedema, or swelling of the limbs that’s a common result of breast cancer treatment, says Dr. Stubblefield, the center’s chief of rehabilitation medicine. In the decade since, Sloan-Kettering’s outpatient rehab team has grown from two therapists to 18, and its focus has broadened. Still, most big hospitals don’t have a doctor like Stubblefield in charge of cancer rehab. “There’s still a very small number of us who are really doing this full time,” he says. Wade, the Florida social worker, never got a rehab referral from her oncologist. Instead, after seeing an ad in her local paper, she began a STAR-certified cancer rehabilitation program at Jupiter Medical Center, a few miles from her North Palm Beach home. Physical therapists helped reduce the swelling in her arm and worked on exercises to improve her strength and steady her gait. Now, Wade says, “for the first time in many, many years, I can go up and down a flight of stairs without losing my breath.” She says she hopes to become well enough to work a few hours a day next year. She’s devoting her energy to advocating for better quality-of-life care, including rehab, for people with cancer. “There’s too many chronically ill cancer patients that are suffering unnecessarily,” she says. via bloomberg.com<http://www.bloomberg.com/news/2011-12-16/a-harvard-doctor-s-startu\ p-trains-hospitals-to-rehab-cancer-survivors.html> [image: App] On the go? *Download Posterous Spaces* for your phone <http://posterous.com/mobile> Sent by Posterous. Is this spam? Report it here<http://posterous.com/emails/gspsqucxgqviGogjvCufJwAxBxkgmH/subscriptions>. 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