"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, May 29, 2010

Challenges for Physical Therapist Managers

physical therapist winnersA physical therapist manager friend of was telling me about his expensive laser and spinal decompression devices and how much they helped his patients. He also mentioned how much money he was making at his two clinics.

He then asked me about the recent changes to healthcare and how they would impact physical therapists.

I told him that the next 3-10 years would bring about a gradual shift from Fee-for-Service to an outcomes-based payment system. A payment system based on patient-reported outcomes will create winners and losers in physical therapy.

Winners: physical therapist mangers with a unwavering focus on patient reported functional outcomes (PRO).

Losers: physical therapist managers that produce QUANTITY but not QUALITY. My friend may lose if he doesn't shift his focus away from his procedures, like laser.

Note: There may be some high-quantity providers who can also generate high-quality outcomes, in fact, there probably are - these are the physical therapist managers who have developed efficient, effective processes for managing patients, getting them better and making money, too.

I challenge providers to identify yourselves if you think you've mastered the process of creating great outcomes. Unfortunately, verifying your claims will be difficult since even the leading PRO provider commands only a tiny market share of the PT industry. That's too bad.

Better management processes are the key to winning vs. losing. My friend thinks that his procedures, like laser, are the keys to quality - but they're not. It's the management process.

The question for the future will be this: Who controls the process of care? Physical therapist managers or the government? Right now the government dominates the process of care with mandates on 'how' physical therapy is delivered. Processes like...
  1. the 8-minute rule
  2. the -kx modifier
  3. 'skilled therapy' (as determined by an 'expert' auditor)
  4. time-in & time-out
  5. PTA supervision requirements based on treatment setting
  6. Minimal Documentation Requirements
  7. 'one-on-one' codes
  8. physician certification of the physical therapy plan of care
The biggest challenge in transitioning to an outcomes-based payment system will go to physical therapist managers. It's the physical therapist managers who have the tough job of...
  • maintaining high productivity,
  • good documentation compliance,
  • high staff morale and
  • excellent clinical outcomes
  • creating management processes that make money and deliver good PRO
Where Do We go From Here?

Costs are increasing but patients, in aggregate, are getting worse. Spine problems in the United States especially are getting worse. This article from the October 2009 Spine magazine states:
"National expenditures for spine problems increased 82%, or an average of 7.0% per year, from 1997 to 2006.

Paradoxically, measures of self-reported mental and physical health and activity limitations among those with spine problems worsened, and the percentage of respondents with spine problems who reported work, social and physical functioning limitations increased substantially during this period."
Physical therapist managers don't know which treatments work and which don't for each patient. From the British Medical Journal, 51% of all medical interventions are of unknown effectiveness.

treatment effectiveness

Physical therapists are good at creating high levels of patient satisfaction (one measure of quality) through caring, face-to-face interaction and hands-on care.

But which interventions create better value? Which create better patient reported functional outcomes? Better patient satisfaction? Lower costs while keeping people living independently? Reduce the risk of future adverse events? Do these following interventions do any of the above?
  • Ultrasound
  • Laser
  • Spinal Decompression therapy
  • Myofascial release
  • Craniosacral therapy
We know, in general, ultrasound and electro-therapeutic modalities tend to decrease functional outcomes. Maybe my friend's laser and other expensive tools will improve his outcomes, I don't know. It's not my role to say so...

That is the challenge for the physical therapy manager.

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.

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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.