"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

Saturday, April 4, 2009

I saw Rosa today in PT...

little old lady

I treated a very sweet lady named Rosa today. Rosa weighed in at over 225 pounds at a little over five feet tall. Rosa presented in the clinic with her rolling walker and her daughter in tow.

Rosa had a physician employed by an insurance company who did everything she could to keep from sending patients to physical therapy because she was financially penalized for referrals to costly ‘ancillary services’.

Rosa had seen pain management, rheumatologists, internists and orthopedic surgeons for persistent unilateral rib pain. Rosa had fallen twice in the period she had been seeking help. She had refused injections and had asked for physical therapy on more than one occasion.

Rosa’s daughter insisted that her mother needed electrical stimulation. The daughter’s chiropractor used electric stimulation twice a month on the daughter's neck ‘for over a year’ to the daughter's apparent satisfaction.

Rosa could barely stand up in from the chair but she ended up that day with me doing many varieties of performance testing:
  • Timed Up and Go Test
  • Functional Reach Test
  • Balance and Reach Test
  • Timed Tandem Standing
  • Timed Single Leg Standing
  • a few impairment measures.
To Rosa's surprise, movement felt better. She could feel the spasms in her rib easing as I had her reach out over her base of support. I could see the daughter was visibly impressed at the tasks I was getting her mother to do.

Rosa left that day feeling better and didn’t get sore the next day. She declined the electric stimulation on the first visit because of time.

Patients like Rosa can often benefit with just one type of treatment intervention. In Rosa' case, reaching offered the greatest immediate benefit.

Rosa's Story is an Example

Rosa's story is an example of the clinical benefit offered by standardized testing. Also, each of the measures mentioned above produced a valid and reliable measurement. Some of the measurements have known change scores that reflect true change to assess progress. Finally, some of the measures are predictive for falls. Improving these measures should decrease the patients' risk of future falls.

Mock Audit

Our clinic started using predictive performance measures after we had a mock Medicare audit performed on five of our "Bulletproof" charts. The audit pointed out 'weaknesses' in our Medicare compliance program, namely, the insufficient use of performance measures in high risk populations.

Your clinic Medicare compliance program can benefit, as mine did, from following guidelines promoted by the Office of the Inspector General, namely:
  • Conducting internal monitoring and auditing;
  • Implementing compliance and practice standards;
  • Designating a compliance officer or contact;
  • Conducting appropriate training and education;
  • Responding appropriately to detected offenses and developing corrective action;
  • Developing open lines of communication; and
  • Enforcing disciplinary standards through well-publicized guidelines
The five charts I sent out for audit have been very helpful to me in upgrading, updating and further "Bulletproofing" my private practice physical therapy Medicare compliance program.

To learn more, sign up for the free Bulletproof PT decision-making tutorial below.

Free Tutorial

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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.

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