"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

Sunday, July 31, 2011

Physical Therapists' Seminar Hosts ACO Expert Lou Galterio

Accountable Care Organizations (ACO) are new entities organized under the Medicare Shared Savings Program. An ACO is a vertically integrated network of providers such as hospitals, doctors, surgeons, home health agencies, skilled nursing facilities and, possibly, private practice physical therapists' clinics.

Lou Galterio, MBA, HiMSS Fellow, will present his knowledge as the Chief Executive Officer of the Suncoast Regional Information Organization (RHIO).

A RHIO is responsible for setting up local Health Information Exchanges (HIE) to connect hospitals with disparate electronic medical records located in individual physicians private offices.

Lou is the guy who will connect the wires that link the acute care hospital and the downstream private practices of physicians, surgeons and physical therapists.

Lou does a good job of making this complex concept simple.

The Florida Physical Therapists' in Private Practice (FLPTPP) will host Lou and several other ACO experts in a two-day seminar discussing clinical, legal, regulatory and technical aspects of ACO formation.

Mike Magidson, Esq of Blalock/Walters of Bradenton, Florida wll present An Overview of Proposed ACO Rules and Regulations for Physical Therapists.

Kathleen Heargraves, CPA of Kerkering/Barberio of Sarasota will present Medicare Audits Under the Shared Savings Program (ACOs).

You can sign up for the August 2-day, 14-CEU seminar here using the web form at the FLPTPP website or you may also register by calling either one of these phone numbers:

1.813.874.2500 (office)

Toll Free: 888-MSK-4331

The course is being held at the Lake Buena Vista Embassy Suites. The Reservation phone number is (407) 239-1144. Ask for the $85 seminar pricing.

Friday, July 29, 2011

Medicare Auditor Describes Threats to Physical Therapists

Come listen to Kathleen Hargreaves, CPA of Kerkering/Barberio in Sarasota speak about Medicare Audits Under the Shared Savings Program (ACOs) at the Florida Physical Therapists in Private Practice Seminar in Orlando, August 20-21, 2011.

Kathleen will describe the threats faced by physical therapist private practices, physician and hospital outpatient clinics, skilled nursing facilities and home health agencies under the new Medicare Shared Savings Program beginning January 1,2012.

The Florida Physical Therapists in Private Practice are a group of eight clinics originally located near Tampa, Florida that incorporated in 2010 as a non-profit physical therapist advocacy group. Our activities this year include the following:

  • the August 2011 Medicare ACO Seminar in Orlando
  • Signing a group discount purchasing agreement with a major national physical therapy supply company
  • Becoming large enough to negotiate with state Workers' Compensation companies for better physical therapy contracts.

You can sign up for the August 2-day, 14-CEU seminar here using the web form at the FLPTPP website or you may also register by calling either one of these phone numbers:

1.813.874.2500 (office)

Toll Free: 888-MSK-4331

The course is being held at the Lake Buena Vista Embassy Suites. The Reservation phone number is (407) 239-1144. Ask for the $85 seminar pricing.

Wednesday, July 27, 2011

Solving America's Most Intractible Problem in America's Most Dangerous City

It's a "Blockbuster Video Moment" from the only doctor in America who may be able to bend the cost curve in healthcare: Dr. Jeffrey Brenner.

Watch the full episode. See more FRONTLINE.

Monday, July 25, 2011

Lower Back Pain, the "The Doctor Effect" and Patient Self-Reported Outcomes

The Doctor Effect is also known as the Placebo Effect.

Except, as pointed out in JournalWatch's Clinical Conversations Podcast #126, Placebos and Medical Meaning, a placebo is an inert substance that has no effect on a patient.

The Placebo Effect was raised by an article in the July 14th, 2011 New England Journal of Medicine Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. The authors found that patients' self-reported breathing after sham acupucture improved while their Forced Expiratory Volume in 1 second (FEV-1) did not improve. The authors concluded that the self-report measures were therefore unreliable.

Dr. Daniel Moreman, author of Deconstructing the Placebo Effect and Finding the Meaning Response, argues that real, therapeutic effects can be measured in patients who take "inert" substances and that the patient experience (eg: feeling better) may be more important than "instrumental', or objective data, like the FEV-1.

At 11:38 min. in the podcast, Dr. Moreman (an anthropologist) directly speaks to the difficulty of lower back pain, patient self-report outcome measures and physician care.

Physical therapists should think about the Doctor Effect because of evidence that the Doctor Effect, or the process-of-care, may provide at least as large a therapeutic benefit as that provided by pharaceuticals with dangerous or deadly side effects.

Sunday, July 24, 2011

Medicare ACO Seminar Features Healthcare Attorney Michael Magidson

Healthcare attorney Michael D. Magidson, Esq of Blalock Walters will present An Overview of Proposed ACO Rules and Regulations for Physical Therapists at the Florida Physical Therapists in Private Practice (FLPTPP) Annual Meeting in Orlando, Florida on Sunday, August 21st, 2011.

Registration details, including continuing education credits for physical therapists and physical therapist assistants, are available at the FLPTPP website.

A Medicare Accountable Care Organization (ACO) is a new type of healthcare devlivery set up under the Medicare Shared Savings Program beginning on Januarary 1st, 2012.

An ACO is a vertically integrated organization run by primary care physicians working for a large hospital or physicians' group. Various downstream providers, including skilled nursing facilities, outpatient physical therapists, physicians' offices and home health agencies, among others, will participate in the care of the patient.

The ACO, and its employees/contractors, will be responsible for 65 quality indicators measuring population health. ACOs who meet all 65 quality standards will be paid a portion of any Medicare cost savings over a certain benchmark.

Michael Magidson, Esq will go into greater detail on ACO regulations at the August 20-21, 2011 seminar in Orlando.

Michael practices in the Business and Health Care Practice groups at Blalock/Walters in Bradenton, Florida. Michael has been advising many of the large mergers happening in the healthcare sector right now. He also counsels clients regarding entity formation and business governance issues.

Physical therapists who want to attend the ACO Seminar can register here.

Monday, July 18, 2011

Demystifying Health Information Technology (EMR/EHR/PHR - What does it all mean?)

As health care professionals adopt information technology within their organizations, a new language has emerged around these activities.
For physical therapists, these terms can be confusing - for example what is the difference between an Electronic Health Record (EHR), an Electronic Medical Record (EMR) and a Personal Health Record (PHR)? How do provisions for Meaningful Use outlined within The American Recovery and Reinvestment Act of 2009 impact physical therapists? Let's start by describing the various types of electronic documentation and their differences.

An Electronic Medical Record (EMR) is an electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

An Electronic Health Record(EHR) is an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be managed by authorized clinicians and staff across multiple health care organizations. It allows integration across multiple settings, provides tools that support clinical decision-making and provides access to electronic data by multiple authorized users.

A Personal Health Record(PHR) is an electronic record of health-related information that can be drawn from multiple sources, where the information it contains is under the management and control of the individual (patient).

The EHR is the primary focus of our government as it attempts to leverage technology to reduce health care costs and business inefficiencies.

According to the Committee on Data Standards for Patient Safety, technology based efficiencies will enhance quality, safety and expediency in health care delivery processes. The core functions of an EHR, according to this Committee, include electronic communication and connectivity, longitudinal collection of personal health information and patient support.

Further, the Institute of Medicine (IOM) stipulates that EHR systems must support the delivery of personal health care services, including care delivery, care management, care support processes, and administrative processes (e.g., billing or scheduling). The IOM suggests as individuals engage more actively in management of their own health, they too become important users of electronic health information.

EMRs and EHRs are tools for providers while PHRs are the means to engage patients in their personal health and well-being. The key difference between an EMR and an EHR is interoperability -- an EHR is used to exchange information across multiple users, an EMR does not.

Although the federally mandated Meaningful Use reimbursement plan is not applicable to physical therapists, multiple benefits can be extrapolated from adopting an EHR including improvements in:
  • Documentation efficiency and accuracy
  • Overall operational efficiency
  • Communication (amongst health care professionals as well as between patient and therapist)
  • Data accuracy and analysis
  • Clinical decision-making
  • Research and outcomes management
  • Coordination of care
  • Reimbursement efficiency

Accordingly, changes are being made in Health Insurance Portability and Accountability Act (HIPAA) regulations to accommodate the use of technology in health care.

As a response, the American Physical Therapy Association (APTA) has recently launched a multi-phase initiative to assist physical therapists with the implementation process -- from decision-making to training and preparation, through the final stages of incorporating electronic systems into clinics (the APTA does endorse products, they just provide guidance on selecting the right solution for your clinic).

When implemented properly, the adoption of electronic documentation has the potential to transform clinical practice for both therapists and patients.

The question remains- have therapists begun to adopt health IT into their practices?

The APTA along with the Health Policy and Administrative Technology Special Interest Group recently conducted a survey measuring EHR/EMR adoption among physical therapists. The results indicate that 28% of those surveyed have fully adopted an EHR/EMR in their practice. Of these respondents, 13% reported they were extremely satisfied and 50.8% were somewhat satisfied. 22.6% of physical therapists surveyed are in the implementation phase of introducing an electronic system.

Given the vast investment by multiple public and private agencies to provide guidelines for health care professionals to embrace EHRs, the significance of technology adoption is clear.

The goal is to continually provide clear and concise information that will hopefully make it easier for the clinician to transition to the world of HIT.

Bronwyn Spira, PT, and Mark Fields, PhD, MPH co-authored this post.

Bronwyn Spira is Founder and President of Force Therapeutics, a web-based comprehensive patient management solution for physical therapists. Also ForceTherapeutics/Facebook and ForceTherapeutics/Twitter .

She owns a private practice in New York City where she treats orthopedic and sports injured patients.

Mark Fields PhD, MPH is a Digital Marketing Associate for Force Therapeutics.

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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 .

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