"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, December 29, 2009

Merry Christmas from First Coast Service Options

Physical therapists have been given the 'gift' of maintenance therapy on some patients.

This 'gift' comes wrapped in bureaucratic gobbledeegook but is still an improvement over the dogmatic, no-way, no-how ban on maintenance therapy paid by Medicare that existed prior to February 2, 2009. (note: the FCSO primary geographic jurisdiction is only in the state of Florida)

Skilled Maintenance Therapy for Safety

The specific reference is located on pages 21-22 of the FCSO Local Coverage Determination.

I'll give you an example of the garbled way in which Medicare makes known it's intent:
"If the services required to maintain function involve the use of complex and sophisticated therapy procedures, the judgment and skill of a therapist may be necessary for the safe and effective delivery of such services.

When the patient’s safety is at risk, those reasonable and necessary services shall be covered even if the skills of a therapist are not ordinarily needed to carry out the activities preformed as part of the maintenance program."
The most obvious example in outpatient PT would have us treating patients at risk for, say, falling down in the home - even if the interventions might be construed as low level, 'unskilled' treatments.

However, the LCD goes on to say:
"It is not medically necessary for a therapist to perform or supervise maintenance programs that do not require the professional skills of a therapist.

These situations include: (among others)...repetitive exercises to maintain gait or maintain strength and endurance, and assisted walking, such as that provided in support for feeble and unstable patients."
The LCD seems to contradict itself: If assessment of falls risk is "complex and sophisticated" then they are skilled.

If strengthening/confidence building exercises to prevent falls could be construed as maintenance, then these services seem to fit the new definition of 'Skilled Maintenance Therapy for Safety'.

It even seems appropriate to set goals for these 'feeble and unstable' patients such as 'No reported falls in 30 days' to measure the impact of our intervention.

Come to think of it, if I've assessed falls risk, constructed goals, designed an exercise plan of care and attempted to measure the impact then maybe I should just treat these people.

Does anybody else read this LCD the way I do?

Maybe next year I'll ask Santa for the gift of gobbledeegook.

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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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