"Physical therapy is not a subspecialty of the medical profession and physical therapists are not medical doctors; we are a separate profession that provides a unique service that physicians are unable and untrained to provide."

Letter to the AMA from the APTA, Dec 2009

Monday, May 19, 2008

Value Centered Physical Therapy

This post comes from a thread in the Yahoo Groups PT Manager listserve between Rick Gawenda, APTA Adminstration Section President and Larry Benz, PT of MyPhysicalTherapySpace.com which discusses the perception that commercial insurance companies like UnitedHealthGroup are trying to emulate Medicare.

This is seen as bad by many physical therapists since Medicare is the most restrictive payer from the notes and charts compliance standpoint.

Medicare also has police powers. That is, if you mess up they may put you in jail.

If there is an organized attempt to model commercial insurance after Medicare then that is news to me.

But, come to think of it - why not?

If we hold Medicare as the standard-setting authority (since professional consensus and practice guidelines don't have any teeth) then could physical therapists follow just one standard?

Can we reduce the goals of the Medicare Manuals (like Transmittal 88) to their intended essence?

The more simple the interpretation of Medicare regulation the easier will be physical therapist compliance and the better will be patient care.

Correct me if I'm wrong (and I'm sure you will) but the Medicare Manuals (and their cousins the Local Coverage Determinations) are aimed at producing three things:

1) that physical therapists demonstrate the medical necessity of physical therapy in their charts and notes.

2) that physical therapists demonstrate that each intervention billed is skilled.

3) that the patient is expected to show significant improvement in measurable function as a result of the physical therapy.

Reimbursement aside, these criteria make for good physical therapy!

If student physical therapists (and old-school professionals) were trained to treat patients with these three criteria in mind then everybody would benefit.

- therapists would benefit from reduced documentation burden (drop the SOAP!)

- therapists managers and administrators would benefit from fewer regulatory constraints by following one standard.

- patients would benefit by increasing focus on measurable function and fewer symptom-oriented and pathology-oriented treatments.

- insurance companies (including Medicare) would benefit from greater transparency in physical therapy charts and notes.

When I graduated in 1992 from the University of Florida I had no training in the disablement model, in physical therapy diagnosis or in describing the medical necessity for physical therapy.

I thought the physician determined medical necessity! (maybe in 1992 they did).

Anyways, it's high time we standardized the 'rules of the road' for physical therapists and physical therapy managers.

If anyone is keeping score then they can count my vote for regulatory standards in physical therapy.


  1. Tim,

    You are right. Autonomy does not imply without accountability.

    Mark F. Schwall, PT

  2. Mark,

    Many people complain about Medicare and other regulations - I like to think they keep us on our toes.



Free Tutorial

Get free stuff at BulletproofPT.com

Tim Richardson, PT owns a private practice at Medical Arts Rehabilitation, Inc in Palmetto, Florida. The clinic website is at MedicalArtsRehab.com.

Bulletproof Expert Systems: Clinical Decision Support for Physical Therapists in the Outpatient Setting is a manager's workbook with stories, checklists, charts, graphs, tables, and templates describing how you can use paper-based or computerized tools to improve your clinic's Medicare compliance, process adherence and patient outcomes.

Tim has implemented a computerized Clinical Decision Support (CDS) system in his clinic since 2006 that serves as a Reminder, Alerting, Prompting and Predicting CDS using evidence-based tests and measures.

Tim can be reached at
TimRichPT@BulletproofPT.com .

"Make Decisions like Doctors"

Copyright 2007-2010 by Tim Richardson, PT.
No reproduction without authorization.

Share PTD with your Peers!

American Physical Therapy Association

American Physical Therapy Association
Consistent with the American Physical Therapy Association Vision Statement for Physical Therapy 2020, the American Physical Therapy Association supports exclusive physical therapist ownership and operation of physical therapy services.