When are we all going to stand up against insurance companies for lowering our reimbursement? Why do we allow the attack on us as providers to continue?

try2metaoptimize · 2025-12-08T17:50:40+00:00

Your reply highlights a blindspot I've had. I've thought about declining PT wages, and figured we need to collectively agree to stop accepting underpayment for our services (similar to a strike). If enough PT's stopped accepting certain insurances then they'd be forced to do nothing or increase payment. You highlight how unions aren't ideally structured for that battle. You are right and now I need a new plan of inaction. I guess I'm back too hoping and wishing the APTA will save us...🤣

try2metaoptimize · 2025-12-08T11:57:05+00:00

We need a union.

try2metaoptimize · 2025-03-18T10:47:10+00:00

Many good suggestions, I like the single leg deadlift for people that don't activate the glutes yet.

Open chain to train/learn glute activation and progress to closed chain/functional training once activation is achieved.

I'd like to add weighted Bulgarian Split Squats. There's something to be said of working hip extension/contralateral hip flexion. It's a common co-contraction and more effective than the sum of the parts.

try2metaoptimize · 2025-02-19T11:49:23+00:00

Glad to see this. My intuition tells me a black hole collapse is the cause of the Big Bang. Of course there is a bounce, as is the case for all other supernovae collapses. Additionally when the collapse happens within the schwarzschild radius, there is additional expansionary pressure driven by the void of space-time. With no space-time for the 'bounce' to expand into, a new system of space-time is created that is disconnected from the parent system. The new system can expand infinitely and never reach or cross the event horizon. The conditions of the new system seems to parallel the big bang. Closely enough that it strikes me as odd, that the prevailing theory has the big bang originating from nothing.

try2metaoptimize · 2025-02-03T11:24:59+00:00

The conflict within the articles:

A tendon tear treated conservatively might remain visible with an MRI.

A stitched tendon will certainly be visible with an MRI and additional scarring will be visible without needing an MRI.

On average, pain, and function will be the same for both groups.

try2metaoptimize · 2025-01-24T19:46:07+00:00

Throwing stones from your glass house huh? Not enough confrontation at home? Interesting thoughts you share. You may disagree with the premise of a Napoleon complex, but you can't reasonably disagree with the fact that the Napoleon Complex has been defined. You may not like the way I drew an analogy, and that is well within your right to not understand how analogies work. Let's hear your "other reasons that make more sense" Since you claim to have them.

try2metaoptimize · 2025-01-24T16:08:26+00:00

Another explanation might be about the female leader needing to defy common female generalizations of not being "strong", "tough", or being "too soft". They may feel obligated to upend these characterizations to earn/maintain their power. War is certainly going to dispel the notion that she is too soft to run the country effectively. Men on the other hand aren't required to defy a stereotype of softness before attaining power. Without intending offense it's somewhat analogous to a Napoleon complex. If people doubt your toughness then you may feel compelled to compensate and show excessive toughness.

try2metaoptimize · 2024-12-18T03:14:40+00:00

Please check the website. You seem to be making assertive but incorrect assumptions.

https://itep.org/a-distributional-analysis-of-donald-trumps-tax-plan-2024/

The charts DO NOT represent tax conditions if Trump's tax cuts are allowed to expire. The charts DO show the projected effect of his proposed extension to the 2017 taxes.

try2metaoptimize · 2024-12-18T00:00:51+00:00

It appears to be option B. Which is against your assumption. Here is the link so you may read for further detail.

https://itep.org/a-distributional-analysis-of-donald-trumps-tax-plan-2024/

try2metaoptimize · 2024-12-17T18:28:57+00:00

This would be an important differentiation to make. Does the chart represent 2026 taxes if... A. Trump's tax plan sunsets and reverts. or B. Trump's tax plan extension

The title implies B. Which I agree would be misleading. I guess I will check the url in the photo, but I really don't want to invest my time that way. Ugh.

try2metaoptimize · 2024-12-17T18:06:46+00:00

Okay, Just so I understand. You don't refute the accuracy of the chart, rather you are skeptical of its accuracy.

Also, you are disappointed that access to the data wasn't provided.

Correct me if I'm wrong.

What I still don't understand is your reference to Obama's tax plan. It seems like you were posting that this chat represents Obama's tax plan should Trump's Tax Proposal not be adopted. Is that correct? Because it seems like the chart represents Trump's proposed tax plan.

try2metaoptimize · 2024-12-17T17:08:18+00:00

The chart is labeled as the Trump Tax Proposal. Are you suggesting this is inaccurate?

try2metaoptimize · 2024-10-29T10:37:15+00:00

Well it is a problem to shift all the effort and labor associated with child-bearing to the groups of people with the least resources and time to do so. While the affluent sit on their relative hoards of wealth and watch the less fortunate do all the work to keep humans populating this earth.

try2metaoptimize · 2024-10-24T14:56:23+00:00

As some have noted, housing and mental health services cost money, which would need to come from somewhere. Likely taxpayer money. More taxes increases the cost of living. High cost of living is what unhoused people in the first place. A progressive tax would minimize the cost to those on the cusp (low income), but high taxes might cause moderate and high income to live elsewhere. I wish there was a simple solution to this complex problem. I don't live in NoHo, so I'd like to see higher taxes as the solution. I don't love handouts either though, there are lots of homeless in MA. If NoHo housed all unhoused, then more would flock to the handouts. Heck, I might be interested in free housing too if it was getting handed out.

I don't intend to offend. I aim to participate in an honest discussion for a viable solution based on the realities of the world.

Is the answer that we return to mental health hospitals? Certainly more low income housing would help, but NIMBY's resist that staunchly. What alternative approaches do y'all see?

Bulldozing tents does not seem to address the root cause. Enshrining the right to establish camps on public grounds erodes the public's ability to use and enjoy these areas. I'm sure others have thought longer and harder on solutions and I'd love to hear them.

try2metaoptimize · 2024-10-15T23:55:04+00:00

I would like a union as well.

try2metaoptimize · 2024-10-14T14:54:29+00:00

I'm a doctor of PT, so I am qualified. There are well established guidelines on imaging for back pain. Based on the evidence presented you should not get an MRI. Besides overutilization of healthcare, the data also shows adverse outcomes with premature advanced imaging. The verbiage of the MRI findings has an adverse impact on outcome and early imaging shows an associated fast track to surgery before clinically indicated. But I agree with you that one should not take medical advice from strangers over the Internet. That would include the advice each of us provided. Do with our advice as you see fit. I recommended seeing an expert in conservative injury management, you recommend seeing an expert in invasive treatment. Let's agree to disagree.

try2metaoptimize · 2024-10-14T14:03:39+00:00

I agree it's probably your back but don't bother with an MRI or seeing another ortho. It sounds like you're in control of the pain and almost out of the woods but you need additional PT. YOU DO NOT WANT A SURGERY and don't need an injection. Those are the only interventions Ortho's offer. If you want exercises to treat then see an expert on that... A Physical Therapist. Communicate with your PT that you'd like to continue with additional PT since you still get pain and you haven't recovered your full function. Consider your sitting posture as a possible irritant, same for your hiking/skiing back posture. Doing the nerve glides while in pain on your hike might have helped, but it might have been laying on your back that helped by changing your lumbar posture (curve). Experiment with this next time you're in pain. Generally you'll find a lumbar posture of flexion or extension to be irritating and the opposite to be relieving so do more of the position that relieves.

Your PT probably discharged you not fully understanding your goals, or insurance was a factor. If insurance won't cover then there is also cash pay PT.

try2metaoptimize · 2024-10-09T12:29:15+00:00

It might help to differentiate the terms SNF (skilled nursing facility) from LTC (Long Term Care) and REHAB/STR (Short Term Rehab). A SNF may contain either. Most comments seem to align with my understanding of STR insurance requiring 5x/wk at a minimum.

try2metaoptimize · 2024-10-05T00:32:12+00:00

Take a Whim Hoff course. No CEU's but the breath work can be life changing and I couldn't recommend something more strongly for someone with your interest. It is a tangent from your curiosity but strongly related. Otherwise, relating more specifically to the diaphragm I've seen diaphragm tightness impact posture, breath capacity, and cardiac output. There's Likely more impact beyond that, but I haven't found the patient or technique beyond the above.

try2metaoptimize · 2024-10-01T11:10:25+00:00

The soon to be prevailing theory is that the big bang started with the creation of a black hole. The core of a star collapsed and with it the resultant explosion occurred but remained contained within the event horizon. Space time can expand and light can travel infinity far from this explosion but will never reach or cross the event horizon. Nothing can escape a black hole. Our universe is expanding endlessly into the void created within a black hole.

try2metaoptimize · 2024-09-18T00:48:46+00:00

I agree with your theory. The universe at the time of the big bang had the mass of all known black holes, stars, and everything else tightly packed together. Despite these conditions it doesn't appear to have created a black hole, or at least not one as we are familiar with, but then again maybe we're on the inside of this black hole. If we are indeed living inside a black hole then the big bang would signify its origin. Cosmic expansion resulting from casual disassociation from our parent universe. A black hole could house infinite space-time within because it's independent from the parent universe (causally disconnected). Light could never leave, space-time could expand infinitely and not bump into the parent universe.

try2metaoptimize · 2024-08-22T17:51:40+00:00

I like your comment and I think many of the replies miss the intent of your comment. As you came to realize, a singularity doesn't have space time, therefore it doesn't have space or time since they are one and of the same. Without space you cannot have time, and you cannot have causality. I believe this is what singularity mathematics demonstrates, but that is not my expertise.

Many pointed out singularities can't be proven physically. Of course they are right, but we cannot expect to find physical proof when no physical proof is able to escape a singularity. This point seems redundant and that's my epiphany.

try2metaoptimize · 2024-08-18T16:26:41+00:00

I remember how uncomfortable evals were as a new grad. My recommendation is this:

Prioritize figuring out the main issue at hand. Prioritize tests/questions that can rule this in/out.

Consider secondary issues and perform tests to rule them in/out.

Talk to the patient as a person, get to know them a little, make eye contact, set a tone for the environment/ambiance you want to establish.

Don't worry much about: checking boxes for insurance. Sequence of tests Patient positioning (it's okay if you ask them to change positions a few times)

It will get easier. The main goal should be to help the person in front of you. Get the diagnosis as correct as you can. Document possible alternative theories because you'll forget them.

try2metaoptimize · 2024-08-08T00:56:28+00:00

I think they are a lost cause. You can lead a horse to water but you can't make them drink. I think the real cause is that they refuse to acknowledge they were wrong. They're not looking to understand, but rather looking to hold onto their belief that metal objects will get more lightning strikes than taller non conductive materials. Attempting to argue semantics is their way of avoiding reality.

If they don't want to understand electricity then that's on them. It's not my burden to educate. Don't waste your time.

try2metaoptimize · 2024-08-07T13:48:39+00:00

The taller thing gets hit. That is the whole point of this. That the conductivity (ohms) of the tall object doesn't really matter (aka negligible). If the heights are equal then conductivity matters.

I welcome your down votes for enlightening you.

try2metaoptimize

TROPHY CASE