"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

Thursday, October 29, 2009

Outpatient physical therapy and 17-page Medicare Evaluations

Outpatient physical therapists get ready - you may soon have to perform 17-page Medicare initial evaluations like your brothers and sisters in home health care.

The project Developing Outpatient Therapy Payment Alternatives (DOTPA) has issued these evaluation forms as 'prototypes' - presumably for provider input.

The proposed evaluation forms are available from the Research Triangle International (RTI) website - get the eval and discharge for institutional settings (eg: nursing facilities) (25 pages) and for community based settings (eg: PTPP).

The outpatient PT discharge note is only 16 pages. Yippee!

The point of this new 'provider burden' is to change the Medicare payment system to a 'value based' system where physical therapists are paid based on the 'risk adjusted' complexity of the patients we see.

For example, if you see a 75-year old patient with the following:
  • lower back pain
  • high fear avoidance beliefs
  • depression
  • lives alone
  • smokes and drinks alcohol
  • appears to have limited understanding/awareness of their health condition and its possible outcomes
...you may be entitled to higher payments based on these listed risk factors.

I say may because no one knows what this alternative payment system will look like.

Currently, the OASIS (Outcome and Assessment Information Set) outcome data does not appear to show outcomes ranked by risk factor.

The most relevant outcome for outpatient care - number of visits - is obviously not as relevant to home health care so we couldn't expect guidance on number of visits.

Utilization outcomes for OASIS instead look at the following:
  • Received Emergency Care
  • Discharged (home) from Home Health Care
  • Admitted to an Acute Care Hospital
OASIS also shows outcomes ranked by state as the percentage of patients who 'improved' - for example:
...of the home health care patients treated in Florida treated between June 2007 and June 2008:
  • 46% improved in their ability to walk
  • 27% were re-hospitalized
  • 17% went to the emergency room prior to discharge
I have a few questions for RTI before they recommend that Medicare implement a 17-page OASIS-style eval/discharge assessment in outpatient physical therapy.
  1. What is 'improved'?
  2. How far did they walk?
  3. How fast did they walk?
  4. Are they satisfied with their home health care?
  5. How long did the episode of care last?
  6. How much did it cost?
Brothers and sisters, what questions do you have?

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.