"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

Tuesday, May 26, 2009

Psst! Wanna see an Episode of Care payment for physical therapists?

How would you like to solve the health care crisis?


Well, you might get your chance. It's called the Episode of Care and its coming to your town soon.

I've spoken about the Episode of Care before on this blog.

In theory, the Episode of Care sounds neat and tidy.

In fact, the Episode of Care is messy and scary.

The American Physical Therapy Association (APTA) has some serious concerns about a 'post-acute care bundling policy' that bundles all payments for a basket of defined health services, like inpatient, surgery, imaging, lab, PT and skilled nursing, into one payment.

The Episode of Care has a 'risk chain' that passes risk down to the last provider on the chain.

US Gov't/Medicare$18-26 billionrising per capita health costs
Acute Care HospitalsEpisode of Care paymentre-hospitalizations
Rehab Agency, PTPP, CORF, SNFCase Rate'Outliers' with chronic and psychosocial conditions (eg: LBP, depression & anxiety)

The APTA, in a Statement for the Record to Senator Max Baucus(D-MT), recommended that any health care reforms...
"...implement programs that include care coordination payments for patients with high-cost, chronic illnesses..."

Wanna know what an Episode of Care payment looks like?

Episode LevelPayment
Level 1$55
Level 2$135
Level 3$225
Level 4$300
Level 5$530

Remember, you take on the risk that the patient, instead of the average 8-10 visits to PT, goes 40-50 visits.

Oh, and by the way, higher episode levels are based on prior surgery within 30 days, not true drivers of chronicity like elevated fear-avoidance beliefs and depression.

Most initial episode levels come in at a Level 2 ($135).

Is it just me?

I don't know - I may have some difficulty solving the health care crisis on $135.

Oh, and by the way, if you're curious where I got the data on episode levels just send me an e-mail.

I may pick your brain on how to solve the health care crisis in PT, as well.

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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"

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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.