"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

Monday, November 29, 2010

Why I Couldn't Participate in the DOTPA Pilot Study

I can't use the DOTPA self-reports for care planning and goal setting in my outpatient physical therapy clinic.

The 17-page evaluation and the 16-page discharge note are not intended to be a part of your patient's clinical record. You are not expected to make clinical decisions based on the data recorded.

I can't use the AM-PAC (from which DOTPA is derived) without paying the license fee. The folks at Research Triangle International (RTI) offered to see if the AM-PAC was available, in the full, commercial version, for data collection - but, it was not.

I am not alone. Researchers associated with the RTI project have objected, on scientific grounds, that the DOTPA project...
"...developed a proposal that demonstrated a scientifically deficient and naïve review of existing instruments available for patients receiving outpatient therapies."
Specifically, the researchers charged, the DOTPA tool is less...
"...sensitive to change (than competing measures) and since payment might be based on these measures, it is essential to have the most sensitive measure for the clinicians to gain the most reimbursement when warranted."
I can't ask my therapists to perform "double entry" for several reasons:
  1. My profit margins not sufficient to support the administrative burden.
  2. Studies of paper-based and computerized Clinical Decision Support systems show that "double entry" is a major source of system failure.
  3. My patients would object.
  4. Pen-and-paper measures are a step backwards in this era of computerization, automation and electronic decision support tools.
Our Medicare Compliance plan is based on the following:
  • data-driven decisions
  • setting quantitative goals
  • knowing when minimal change occurs to demonstrate progress
  • knowing, based on quantitative progress scores, when to apply the -kx modifier for patients eligible to exceed the $1,860 PT/SLP cap
Using the DOTPA tool would not only have imposed expensive and time-consuming burden on my therapists but my physical therapy notes would have become LESS COMPLIANT for Medicare.

Who can use the DOTPA tool?

Interesting story.

I invited a friend and a peer to listen in and share notes on my phone line to the original RTI conference call on August 19th, 2010.

She was using, at that time, NO outcome measures - for her the DOTPA project was a step in the right direction.

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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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