Letters and Questions

Can Chairman Baucus include in his letter some other stuff like getting rid of plan of care, physician referral requirement, explicit provider list, inconsistent supervision between part A and part B? 

Can Baucus remind them that outpatient PT is less than 2% of part B budget and is the only medical service that went down in real dollars (not the make believe government decrease from increase one’s we always read about) between 2004 and 2006 per their own data?  This is despite the fact that more beneficiaries were treated than the prior years. 

Can’t we get a little pay for performance via some relief from the very regs that are putting freestanding outpatient clinics under huge financial strain and compliance pressure trying to determine if their manual therapy intervention is group therapy or not?

Will Secretary Leavitt throw Baucus’ letter away like he did mine.

Does government really run this way?  First, hold our claims. Second, clarity on caps/modifiers and now, hold the phone caps might be cleared.

Anybody for Gov’t run universal health care?

larry@physicaltherapist.com

Cool Patient Simulation

Medscape has a cool, interactive continuing education option - patient simulations.  Of course, I'm not a physician, but it is always interesting to me to view the perspective of physicians and how physicians problem-solve.  As I played with the simulations I was excited to learn that physical therapy was actually an option for consults/orders.  In this particular series of patient simulations, the focus was on managing joint pain and swelling.  There was no doubt in my mind that in 2 of the 3 simulations, physical therapists should have a role.  Sadly enough, 0% of the physicians recommended a physical therapist!  The physician focus was highly skewed toward pharmaceutical management.

The simulations were pretty cool though.  It would be fun to have something similar for physical therapists.

Selena Horner

Physical Therapists and the Great Divide

For those of you in the United States, if you have a thumb on the pulse of physical therapy, you are noticing more and more opposing views on a variety of topics.  Because of transparency, it is easily observed through forums, blogs and list serves that our profession is divided on a variety of issues:  use of ultrasound, the theory of the biomechanical model for some manual therapy approaches, manipulation, evidence-based practice, the educational model, dress code...  (do we ever agree on anything?)

We have a divide in our profession on these most important issues.  Like it or not, the most important issues are key to our survival as a profession.  The majority of physical therapists practice in an outpatient physical therapy setting.  Regulations that affect our ability to practice efficiently, our ability to generate a profit, our ability to determine staffing and use of staff, and our ability to create and design our own business models will negate any benefit we may reap as a "doctoring profession," the vision of 2020, or being neuromusculoskeletal experts because of the risk of becoming extinct. The divide on the behalf of one group is based on perceptions and emotions. Generally, it never does much good entering into an emotionally charged discussion, which is why I have held my thoughts back.  Reality is, we need to talk; we need to learn to compromise; we need to learn to negotiate and we need to reduce this divide to increase our likelihood of survival.

The majority of the state practice acts are direct access. There is a frivolous suit out there initiated by the NATA against the APTA. Fair practice is being argued. What about CMS? Doesn’t CMS affect our “fair practice?” Doesn’t imposing physician referral oppose a state practice act of direct access and reduce our ability to practice? Safety is always cited as the rationale for physician referral, but what does data suggest? Do states that have direct access have a substantially higher amount of malpractice suits involving Medicare beneficiaries? Doesn’t CMS also affect our “fair practice” by dictating and micromanaging clinical decisions related to supervision and delegation?

A big beef of mine is the one-on-one CPT code definitions for the outpatient setting. Assumptions have been made; beliefs have been formed; one-on-one treatments are superior and anything different is suboptimal. Hasn’t anyone actually wondered if assumptions are true? I have. We have more and more research indicating that subgrouping patients and treatment based interventions will increase the likelihood of effective treatment. Could the same be true for one-on-one versus group situations? (Group will be defined as 2 or more concurrently scheduled patients with their own individualized plan of care in an outpatient setting.) No one has argued the benefits for group situations other than the financial component. In the past, I have treated 4 concurrently scheduled patients in which I had full control of the mix of those patients attending for services. There is definite benefit with the right mix of patients. The patients amongst themselves motivate each other, support each other, some compete with each other and applaud each other. I even have some data that I have analyzed to answer my own question as to whether there is a difference in outcomes between the services I provide in group situations or one-on-one situations. For me and my practice, if someone had a lumber or lower extremity complaint, there was no difference in the functional outcomes between the two groups. Patients with a cervical or upper extremity complaint had on average pretty much a whole minimal clinically important difference between scores with better function obtained for the group situation. I have no idea what happened differently between groups but that’s pretty substantial. For me, dictating one-on-one treatment sessions reduces the effectiveness of outcomes for those patients. What about costs associated with care? Overall comparison of group situation versus one-one-one situation indicated on average 2 less visits. So, am I being cost effective with one-on-one treatment sessions? The definition of those codes reduces our clinical and professional ability to assess various treatment models and options to increase our effectiveness and efficiency.

There have been round and round discussions about “skilled” and PT extenders. In my opinion the “skill” in what we do is the design of the package we create within the written plan of care – the progression of interventions to meet defined goals for each individual patient. There is definitely a time and place for PT extenders and I’d assume the variables that impact the clinical decision for utilizing PT extenders are frequency of visits, patient co-morbidities, stability of patient presentation, severity of patient presentation, patient previous response to treatment… The emotionally laden discussions never really discuss the variables to consider when delegating, but instead fall back onto “skilled.”

Some arguments for PT and PTA only treatments cite safety as a rationale. I requested the Physical Therapy Claims Study from CNA/HPSO. What’s actually happening out there with liability claims? From January 1, 1993 through March 31, 2006 there were 1,464 closed and open claims (number might be off because there could be more open claims that haven’t been filed yet). When looking at closed claims, if there were 140 to 160 claims for 51,000-56,000 policies about .28% of the policies had a liability claim. I get the impression that quite a few therapists believe that PT extenders are used at too high of a frequency and inappropriately. With just that small amount of data, it doesn’t seem from a risk management perspective that PT extenders increase liability claims, IF the therapists that believe they are used at too high of a frequency are accurate in their beliefs. 77% of claims occurred in a physical therapy office or clinic (non-hospital). Claims that occurred from services provided in a nursing home were the highest, averaging $76,000 compared to about $38,000 for physical therapy clinics. The highest occurring primary injury was fractures at 27%. The second highest primary injury for claims at 18% was burns that had an indemnity payment of $25,000! (We argue and discuss PT extenders and “skilled” and maybe we should consider the risks and costs associated with heat modalities that haven’t even been shown to be effective!) The allegations: failure to supervise treatment/procedure at 15% of claims, injury during manipulation at 11% of claims, improper technique at 11% of claims, injury during heat therapy at 10% of claims and injury during resistance exercise or stretching at 7% of claims. The reason that I think the liability claims data is interesting is because CNA/HPSO of course wants to share the information with clients so physical therapists can be aware of what is happening to reduce risk which will actually increase profit for CAN/HPSO (less claims = less expenses and less indemnity payments). Within the recommendations for risk management, nothing was stated on eliminating PT extenders or suggesting that PT extenders were a variable in failure to supervise claims. The recommendations do not suggest that treatments provided only by PTs or PTAs reduce risk. The Study

We could be WAY ahead of the game if we had a definition of quality of care.  Outcome numbers to determine if the issues revolving around one-on-one care and use of aides are issues or non-issues would be helpful also.  Does anyone have this type of information?  FOTO has been around for quite some time, does anyone have any data to share that might help resolve differences of outcomes when dovetailing patients?  What about data to compare use of PT extenders or no PT extenders?  If there is a difference, is it statistically relevant?  Are we divided over a non-issue?

It would be interesting to see a discussion revolve around these issues that reduce our capacity both financially and professionally based on something other than opinion and emotions.  Can we present data to support thoughts? It’s almost as though professionally we have been brainwashed to believe something without any substantiating evidence. Show me why aides shouldn’t be utilized; show me why CPT codes state one-on-one and this is believed to be the best option for patient care; show me why a physician needs to refer; show me why a physician has to approve a plan of care.  Can we reduce our professional divide by eliminating the emotion and replacing emotion with some level of supporting evidence?

Do others think about these topics?

Selena Horner

Miss Connecticut "Absolutely Loves Physical Therapy"

Some positive thoughts are in order today in honor of everyone losing some greenbacks as the new Medicare rules take effect.

First up, we must all extend our congratulations to the newly crowned Miss Connecticut, Ashley Glenn, a Doctor of Physical Therapy student at my awesome alma mater, Quinnipiac University!! 

You can follow this link to view an interview with Ashley where she talks about her platform, which includes therapeutic exercise and dance.  It will be fun to watch Ashley, who is automatically dear to our hearts, as she competes in the upcoming Miss America pageant.  It will be nice to hear her physical therapy connections highlighted on a national stage (and Quinnipiac too!).  Good luck, Ashley!

Next, I'd like to call you attention to this fine blog post by Roderick Henderson at the Orthopaedic Physical Therapy blog.  He takes the normal grumbling and complaining, puts a new spin on it, and offers some solutions.  The result is that he makes some good points in what I found to be an inspiring post.  I especially enjoyed his ideas for action.  My favorite:  "Conscious effort beyond the call of duty is required to shift this equilibrium toward a favorable outcome."

Finally, did you know smiling can make you happy even if you're not already?  Give it a try!

ERIC

Rage and Furor

that’s the only way I know to describe the sentiments of PT’s and the entire medical community over the inability of the Senate to pass HR 6331 which would have avoided a 10.6% cut in fees for medical providers and for us PT’s it would have extended the exceptions process.

My observations:

-the method to avoid the fee reduction was actually well founded (and reported many times at this blog including here and here and here) in that it sought to reduce the premium paid to private insurers that is above the cost that CMS could administer the plan itself.  I believe Mr. Obvious would site that politics played a role in the Senate not passing this

-A system where the cap is in place for everybody but hospitals is just illogical as CMS’ data clearly shows that hospitals are losing significant market share in patients obtaining care in that outpatient setting. I challenge anybody in the profession to explain with any logic the reason that hospitals are exempt

-I am steadfastly against a cap for most of the traditional reasons that have been cited but also because it is unprecedented in the CMS system.  Can you imagine a cap on imaging or seeing a family physician?  Does CMS easily forget that PT is less than 2% of their budget?

-I am equally against the exception process. All it does is increase our cost (essentially decreasing reimbursement) thru an additional administration burden that while occurring infrequently casts a disruptive process to a PT clinic

I predict that somehow the 10% reduction will get dealt with because it is an election year.  I am not as confident on anything related to PT.

I highly commend APTA and groups like PTPN for their yeoman’s work in organizing the troops of PT’s to lobby for the passage of the legislation in both the Senate and the House.  What I cannot understand is why can’t we get the same sense of mobilization for the rules that CMS has put in place that profoundly impacts PT at much greater rates and financial implications than the Cap?  Why can’t we get PT’s on Capital Hill with the same rage to fight for the following:

-complete elimination of the stupid plan of care requirement that has gone from 30 days to 90 days without any clear implementation (now I know how Seniors felt about figuring out their new Medicare Part D drug benefit).

-elimination of all of the rules that are directly against practice acts and eliminate judgment by PT’s who are now in supposedly a “doctoring” profession including 8 minute rule, explicit providers of PT and PTA’s only, supervision requirements of PTA’s and students that are grossly inconsistent, the whole “group” therapy mess, and elimination of the requirement of physician referral

Why do we simply sit back and assume the position referred to in the 1978 film Animal House along with its phrase “thank you sir may I have another” ?

Perhaps the time has finally come when the PT’s around the US can lobby for all of these things together rather than a piecemeal approach that overemphasizes a cap that occurs at much less frequently than the practice superimposed rules that severely marginalize our profession and undermine the professional medical judgment of a PT.

Thoughts?

larry@physicaltherapist.com

Terminal Degree? Doctor? Felon?

The AMA may be going bananas about the evolving world of healthcare and the evolving role of physicians.  Larry implored the AMA to forget their proposed movement to restrict the use of the terms "doctor," "resident," and "residency" to physicians and just go golfing instead.  Well, it seems that some must have hit the links, but not all.  Ultimately, the AMA chose to abandon that resolution and instead adopted a resolution which calls for legislation that requires health care professionals to "clearly and accurately identify to patients their qualifications and degree(s)" and make it a felony to "misrepresent one's self as a physician."

Insiders at the meeting feel this resolution could be used by some state chapters to move through legislative efforts to limit the use of those terms, perhaps making the "misrepresentation" a felony!  Illinois, watch out, as it was that state's delegation that introduced the initial resolution. 

I found this letter from the American Society of Health-System Pharmacists (pdf) commenting on the proposed resolution, which apparently played some role in the movement away from the restriction of the term "doctor".

This article contains a list of other actions taken by the AMA at their recent meeting which serve to protect a physicians right to control your healthcare.  Remember when the AMA acted to make it a felony for any physician to voluntarily associate with an osteopath?  You can read about the AMA history with Osteopathy at Wikipedia. 

When considered historically, how can we trust all these actions that serve to protect physicians' scope of practice?  Is it possible there are cheaper, more efficient ways to obtain good health?

ERIC

Leveling the Playing Field

On June 23, 2008 the New Jersey General Assembly took the first step in restoring some sense and reason to the practice environment for Physical Therapists and healthcare consumers in the State of New Jersey by overwhelmingly passing Assembly Bill 2123 (A-2123).  This landmark piece of legislation seeks to establish standards of coverage and reimbursement that are commensurate with the standards of practice by which Physical Therapists in New Jersey are bound to abide.

A-2123 assures consumers that the coverage that they and their employers pay so handsome a price for will indeed provide services without arbitrary caps on payment for services rendered or visits for medically necessary services.  As we are all painfully aware, third party payment for Physical Therapy services has been in a downward death spiral.  A-2123 establishes a floor of reimbursement based on an already existing PIP fee schedule established by the State of New Jersey below which the insurers' liabilities may not fall.  It also provides for the elimination of capricious and arbitrary visit authorizations less than those proposed by the treating Physical Therapist's Plan of Care should authorization be sought.  This legislation also makes Direct Access an affordable option for consumers by eliminating all referral requirements for third party payment for Physical Therapy.  There are a host of other benefits of this legislation which are covered here.

When all else has failed there are other avenues that are available to combat the deterioration of the practice environment and the legislative arena is the one most apropos when all other avenues have failed to produce satisfactory outcomes. 

The Senate companion bill of A-2123 was introduced last week as well in the form of S-2072.  I for one am looking forward to the passage of this bill as well and the eventual enactment of this legislation by the stroke of the Governor's pen.

Summertime PT Fun Test-see you how you do

It is time for the first annual “are you smarter than a PT regulator?” test.  We will start out with a sample question and then get right into it.  Please do not look at the bottom for the answers and explanations until you have completed the test.  Be honest, post your scores and your thoughts.  If you are too scared to post them on the blog, please email me privately.  Academic programs-particularly interested in how your students performed.  Perhaps it might be better for them not to take this since it might scare them out of the profession!

I realize that PT’s are exam phobic. However, I thought this was the best way to illustrate the absurdities in our industry.  Sorry in advance for the length of this blog post.

Sample Question:

Which of the following are the only providers under medicare’s rules to have a physician signed plan of care:

A. Chiro’s

B. Optometrists

C.  Physical Therapists

D. Dentists

E. Proctologists

The answer is C of course.  Why don’t we fight against this? who knows. In fact the recent change from 30 days to 90 days has caused more confusion and questions than it has answers, particularly the physicians who are now asking questions about plans of care that last 10 weeks!!

 

Medicare Physical Therapy Economics:

1. Which of the following received the most payments in medicare for PT services:

A. Hospital

B. Skilled Nursing Facility

C. Physical Therapist Private Practice

D. Physicians

E. Outpatient Rehabilitation Facility

 

2. Hospitals have always been exempt from the medicare cap.  Between 2004 and 2006 which provider setting has seen a decrease in percentage of medicare beneficiaries seen in their setting:

A. Skilled Nursing Facility outpatient (medicare part B)

B. Hospital Outpatient

C. Physical Therapist Private Practice

D. Outpatient Rehab Facility

E. All but C.

 

 

3. Approximately 8.5% of the 43 million medicare patients annually access PT. What percentage of the 179 billion part B medicare budget goes to PT?

A. 2%

B. 4%

C. 6%

D. 8%

E. 10%

 

4. There were approximately 4% more PT’s seeing medicare patients in 2006 than in 2004. This resulted in the following:

A. about a 4% rise in physical therapy expenditures in 2006

B. a 10% rise in 2006 sending all kinds of “red flag” to medicare about PT usage

C. There was no change in expenditures between 2004 and 2006

D. There was more than a 5% decrease in PT expenditures between 2004 and 2006

E. None of the above are true

 

Medicare Regulations:

5. Which of the following are not allowed as billable time under medicare:

A. A ventilator dependent skilled nursing patient is in being treated by a student under supervision of a PT.

B.. A ventilator dependent skilled nursing patient is being treated by a therapist extender under supervision of a PT.

C. An ATC working as a therapist extender is counting the number of straight leg raises of a medicare patient.

D. A physical therapist assistant working solo in an outpatient rehab facility is performing manual therapy on a patient.

E. PTA working solo in a outpatient rehab facility is doing soft tissue massage

 

6. A PT is working with a medicare patient.  After examination and applying a clinical prediction rule, the PT decides to do a manipulation thrust technique on a patient which after looking at his clinic supplied (and CMS approved) stopwatch took 5 min.  Concurrently, a therapist extender is working with a non medicare patient counting the number of straight leg raises.  What is the correct billing?

A.  Wow, too difficult to tell-so I will take the safe route and bill it as “group” or not charge at all

B. A no charge on the thrust technique since it took less than 8 minutes.

C. Assuming the pre and post treatment times are added to the stop watch, it is a safe assumption that it took 8 minutes BUT the concurrent patient was being supervised by the PT so the thrust technique is “group” therapy.

D. Manual therapy thrust techniques are not allowed on medicare patients-at least not in my clinic.

E. This scenario is stupid. It is immoral, unethical, and impossible to manage more than one patient at a time and the fact that you have even used the words therapist "extender" is a disgrace to our profession-am done with this stupid quiz that I am failing.

7. Which of the following are part of a typical state practice act in PT:

A. Certification plan

B. 8 minute rule

C. Restriction on billing for work performed by students in an outpatient setting

D. Explicit definitions of PT and PTA as the only providers of service

E.  None of the above

8. Which of the following according to CMS are not allowed to make “clinical judgments”?

A. PT

B. PTA

C. ATC

D. Therapist Extenders

E. All but A

9. Which of the following payors most restrict the clinical judgment of a PT?

A. CMS

B. United because they pay the least.

C. Work Comp

D. Private payors in general

E. None of the above.

10. Many hospital PT’s are very concerned that effective July 1, PT extenders under direct supervision will not be allowed to work with medicare patients and have their “minutes count”.  Which National Organization has lobbied for the continued use of therapist extenders in the part A environment:

A. APTA

B. NASL

C. AARP

D. ASPCA

E. NAFTA

11. After Nuclear Power plants, which industry is the most regulated:

A. Health Care.

B. Construction.

C. Insurance

D. Financial services

E. Pharma

12. Which of the following will most help Tiger Wood’s with pre-op exercises?

A. Self-help DVD

B. An exercise sheet of knee exercises given by a physician with a popular anti-inflammatory as the sponsor of the exercise handout

C. a Nintendo Wii

D. A therapist extender under supervision of a PT after a clinical exam by the PT

 

13. A Senior PGA tour player who has medicare has just been referred to PT for knee pain.  Which of the following are not considered billable?

A. A therapist watches a self help DVD with a patient

B. A PTA reviews the exercise sheet given by a physician

C. PT plays Nintendo Wii bowling with a patient

D. an ATC (therapist extender) under supervision of a PT and after a clinical exam by the PT is working with the patient on straight leg raises

E. all of the above are billable under medicare

 

14. All of the following are supervision terms used by medicare except:

A. General Supervision

B. Direct Supervision

C. “line of site” supervision

D. “same room” supervision

E. All are terms used by CMS

 

15. Hospitals are exempt from medicare’s cap for outpatient PT.  This is because:

A. Hospitals are the preferred provider of CMS

B. Hospitals have shown that they are the most cost-effective providers of outpatient PT

C. Hospitals have always believed that all PT should be “one on one”

D. Hospitals have the lobbyists with the biggest bucks and biggest influence in Congress.

E. Nobody really knows-just another stupid rule by the government

 

16.  The medicare cap for PT is combined with speech and language pathologists while OT has its own cap.  The reason that it is combined is:

A.  Everybody knows speech therapists really want to be PT’s so they just went ahead and combined them

B.  Allows co-treatment of PT and Speech without regards to total dollars

C.  So few outpatients need speech that they figured “what the hell, let’s just combine them”

D. They knew they couldn’t combine PT’s with OT’s or there would have been a hell of a dogfight

E. Nobody really knows-just another stupid oversight by the government

 

 

ANSWERS:

1. C.  PTPP dominate the medicare outpatient physical therapy world with a 35% market share with hospitals having 21% and physicians 9%.  Although PTPP is by far the largest, it cannot be determined how much of PTPP is truly outpatient PT owned by PT versus outpatient PT that is owned by MD’s.  We do know that the biggest rise between 2004 and 2006 data was PTPP and it is presumed to be physician owned growth since that is when MD practices were allowed to start applying for their own PTPP numbers. In fact, physician data to CMS actually decreased during this same time due to the transition of MD practices billing “incident to PT” to PTPP.

2. E.  All  but PT in private practice have seen a decrease in the number of medicare beneficiaries in their setting.  Right wrong or indifferent, physical therapy private practice is where the medicare “action” is yet the ridiculous superimposed rules by CMS are making financial viability in a private practice challenging to say the least. I am sure there are several reasons why medicare patients don't go to hospital outpatient clinics for PT even when they have a financial incentive to do so.

3. A.  In fact, it is less than 2% at 3.05 Billion.

4. D.  Per CMS data PT expenditures went from 3.23 B to 3.05. They are trying to credit the medicare exemption process. Grade them an F for terrible analysis.  This is surprising since hospitals are exempt from the cap but then again, hospitals are losing substantial market share in outpatient PT.

5. C.  CMS allows students and therapist extenders on part A medicare but not part B. Don’t try and figure it out-logic won’t work.  I have no trouble with the therapist extender in these settings as  I fundamentally believe that PT’s can and should be in the position to make those determinations.  Unfortunately, the trend within our profession is to eliminate all therapist extender positions within an outpatient setting under the mistaken belief that the care is “unskilled” or that all PT requires “clinical judgment”.  Their stupid argument goes something like this: Why should an insurance company pay for services that are “unskilled”?  Is taking height, weight, and blood pressure skilled? (ok, sorry about a “quiz within a quiz”).  Does medicare pay for those services in conjunction with a physician’s exam?  The only factor that should matter to any payor is whether or not the PT is acting within their scope of practice.  Just because something is “skilled” is not the benchmark for payment as any profession has to have support services and a complete inability to pass the cost of the support services along so that a therapist can be more efficient destroys the utilitarian ability of a provider and the ability to be the most cost effective.  Don’t all professionals have support staff that assists in an overall delivery?  Lawyers use paralegals or clerical help that they bill for as do accountants and almost all other “real” professions.  On the one hand, we want to be the Vision 2020 Doctoring “profession”. On the other hand, we want to police ourselves out of an industry under the mistaken belief that we need to "clean" ourselves up or that it is immoral professionally to use support help.  Let’s fight for consistency in all settings which allows PT’s to use their judgment in accordance with their practice acts and keep in mind most practice acts have provisions for support “extenders” which calls for some level of competency and review of competencies. 

6. C but this question would not reach the threshold of psychometric properties since answers would be all over the place and it would have to be tossed out of the test.  The number of similar type questions are constantly being asked and debated in clinics and listserv’s throughout the US.  What a waste of time.  PT’s don’t go to school to figure out some counter-intuitive definition of group therapy.

7. E.  All of those are part of the medicare superimposed rules that are breaking the backs of PT’s.  We get so used to them that we often think they are part of our practice act.  Shame on us.  We need to fight for their elimination rather than passively sit back and have CMS keep adding them towards our extinction.  We also need to restrain the efforts by many in our profession who are actively promoting CMS as the standard and are pushing for all payors and practice models to adopt them as standard.

8.  E. Per CMS’ own language   PTAs may not provide evaluation services, make clinical judgments or decisions or take responsibility for the service. They act at the direction and under the supervision of the treating physical therapist and in accordance with state laws.” Since we know therapist extenders can’t likewise make clinical judgments why don’t they let their work count since they are allowed in almost all state laws?“

9. A.  Most practice acts allow for the use of therapist extenders provided they have received training and an annual review of competencies.  By disallowing therapist extenders (outpatient only under CMS) they restrict the therapists decision making in delineating what it most cost-effective resource that should provide intervention.

10. B. The National Association for the Support of Long Term Care.  Why hasn’t APTA stepped up to plate on this?  Perhaps they are too worried about the politics of “taking sides” in an organization that is split on the use of extender issues.  My take is they have no guts.  A simple and defensible position ought to be “We believe that PT's are fully capable of acting within their scope of license within their state practice acts.  In regards to the use of extenders, provided their state practice acts allow for this, we defend a PT’s ability to make clinical judgments for the patient's best concern”.

11.A.  This one isn’t even close.  More federal and state regulations for health care than any other industry than nuclear power!  Think of HIPAA, ADA, OSHA, corporate compliance, etc. etc. As an aside, nuclear power plants have a problem called NIMBY (not in my backyard).  Perhaps CMS doesn’t want a PT clinic in your backyard either!

12. D.  Hope there is little debate on this one.  My assumption is that a room full of academics and practicing PT’s would come to the same conclusion.

13.D.  Crazy world we live in.

14. E.  Aren’t you glad you went to PT school to learn at least 4 different types of supervision!!

15.  E.  Lots of speculation, no real explanation.

16.E.  PT represents over 75% of all outpatient therapy spending.  It makes sense to combine its cap right?

Post your grades and your thoughts please.  Hopefully many of the question will irritate you and perhaps even convince you to come onboard a grass roots movement to “operation restore PT”.  We have let regulators “gone wild” on our profession and need to restore logic and reason to rules and regulations so that we can spend time providing the best in evidence-based care to our patients rather than worry about “line of sight” supervision and determination of “group” therapy.

larry@physicaltherapist.com

 

Those Pesky Self-Help DVD's Again

I've never been a fan of Advance for Physical Therapists & PT Assistants.  (I'm still not a fan.)

For some reason, this kindling made it to my door... and for some reason I opened it up.  The last page happened to have the opinions of 4 individuals on self-help DVD's for various common conditions.  We've discussed this before, I know.  I was just floored by the lack of the ability to truly respond to the question and the opinions presented. 

Let me paraphrase the responses to:  Do rehab clinicians feel these resources play a role in easing painful conditions?

PT #1:  They are a treatment option.  Therapists must be aware of the vast amount of information and offer professional guidance.  My thoughts... Hello... if the potential patient is purchasing a DVD, do you really think you're going to have the opportunity to offer any professional guidance? 

PT #2:  Using the latest technology is just one avenue to give people the freedom to live a pain-free life.  My thoughts... Oh, oh... so as our research points to defining subgroups of patients and their responses to particular interventions, will a person really be able to identify the appropriate subgroup and match the appropriate exercises/tasks?  Hmmm, and is a pain-free life realistic?

PT#3:  Selling DVDs is a source of cash revenue and can promote physical therapist expertise. My thoughts... ummm, well, does the DVD ease painful conditions?  Will the DVD meet the expectations?

MD #1:  Why, oh why, did our fellow colleagues not sound as fabulous as his response?  Ryan Reeves, MD  "Without appropriate supervision and guidance, patients miss out on the integration of their clinical signs, symptoms, exam findings and test results."  I loved his final ending, "Without guidance, the most you should expect is mediocre outcome."  The only negative with Ryan is it appears he's practicing in a referral for profit situation.

Let's pretend the DVD's do have great information and are created by physical therapists.  If the consumer has the expectation that the self-help DVD will resolve the current complaint because the DVD was created by a physical therapist expert... but then the DVD wasn't beneficial, didn't help or made things worse, how exactly will we be viewed? 

It might be nice to see a clinical trial where patients are provided with a DVD and allowed to make all the decisions (with pre and post outcome data) and compare their self-help outcomes to physical therapist directed services.

Selena Horner 

How about "Cure from CMS" ?

and any other payors that superimpose rules that are above our Practice Acts?

The AMA released a campaign today called Cure for Claims complete with a report card. 

Per AMA Board Member William Dolan, “The goal…is to hold health insurance companies accountable for making claims processing more cost-effective and transparent….eliminating the inefficiencies of the billing and collection process would produce significant savings that could be better used to enhance patient care and help reduce overall health care costs…”

Amen!

I love their report card and the metrics that it measured and believe they are consistent in the PT world.  The adherence to contracted rate ranges from 61% (United)to 98% (Medicare).

Thoughts?

larry@physicaltherapist.com