"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, July 14, 2009

Physical Therapists' Predictions Create Value for Patients and Society

Make predictions using walking speed as a diagnostic and prognostic predictive tool.

Show medical necessity for Medicare physical therapy patients using walking speed as part of your clinic's compliance plan.

When over 40% of all Medicare claim denials are based on Medically (un)Necessary physical therapy and when SO many people need physical therapy it seems apparent that we need quick, simple tools like walking speed to assess who needs (and who doesn't need) physical therapy.

Stacy Fritz, PT, PhD and Michelle Lusardi, PT, PhD recently published Walking Speed: the Sixth Vital Sign in the Journal of Geriatric Physical Therapy.

It seems that Drs. Fritz and Lusardi's tool couldn't have come at a better time.

The current administration is trying to create 'value' in the health care marketplace. Value is typically described as...

Value = Quality / Cost

The trouble is that different groups define 'quality' differently.
  • I define quality as the best possible functional outcome for my patient.

  • A surgeon might define quality as an x-ray showing bony fusion.

  • An insurance company might define quality as fewer PT visits or fewer MRI scans per episode of care.

  • The federal government might define quality as a 'public option' that covers 100% of Americans with a basic basket of health care services.
The stated goal of CMS and private/public actors like DOTPA is
"...to develop payment method alternatives to the current financial cap on outpatient therapy services."
Yet these partnerships promise to deliver fruit in no less than five years! You and I can't wait that long - your patients can't wait that long.

Dog Days

As the summer winds down and the second half of 2009 rolls around you will start to see more and more patients who have hit their annual, per beneficiary financial limit (the therapy cap).

How will you justify your services?

In my town, the largest provider of outpatient physical therapy services has a blanket policy...
When the patient hits the $1,840 Medicare cap for PT services they are discharged - no audit risk here!
Unfortunately, our health care market incentivizes physical therapists to deny needed services to eligible patients based on audit risk to the physical therapist.

I Love my Country but I Fear My Government!

Physical therapists need predictive tools that we can hang our hats on when recommending continued therapy for patients over the cap.

Walking speed is also helpful at the evaluation since the physician cannot determine medical necessity for the initial plan of care - that's the job of the PT.

That comes as a surprise to many physical therapists - making accountable decisions is a responsibility many of us are not ready for.

Well, get ready. Walking speed is a new tool that will help you show need and progress if your patient exceeds the $1,840 cap.

Physical therapists shouldn't feel bad

Chiropractors are no better at determining medical necessity and showing functional progress.

47% of chiropractic claims were paid by Medicare in error. Chiropractors should use Fritz' walking speed bar graph to show need and progress for their Medicare patients.

Walking speed measurements are quick, inexpensive and effective. We have no reason not to use them.
Special thanks to Selena Horner, PT blogging at MyPhysicalTherapySpace.com .

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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