"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

Wednesday, August 31, 2011

California POPTs Job Loss Differential

In 2005, in Manatee County, Florida a POPTs clinic opened which eventually grew to 17 interventional pain medicine and orthopedic surgeons. I was asked to run the POPTs clinic. I declined.

The clinic grew to employ at least 15 physical therapists in 3 separate locations - in some cases with no full-time physician oversight because they couldn't keep track of who was supposed to be where, when.

In the subsequent two years, 23 independent clinics closed in Manatee-Sarasota county. Each of these clinics employed at least one physical therapist. Many of these clinic employed more than one therapist and 1-3 additional support staff. I closed one of my clinics that employed seven people!

I estimate that with the closing of these 23 independent clinics the job loss differential was probably close to 50 jobs in Manatee-Sarasota counties in that two year period.

Back then, no one complained about jobs. Those were BOOM times in Bradenton. We trailed only Las Vegas in the growth rate of new home construction.

The situation in California now is different. Jobs are scare. If POPTs proliferate they will destroy more independent physical therapy jobs than they create.

My evidence indicates that a 50-to-1 job loss differential is not an unreasonable number.

Comment at the NBC/Los Angeles news website that has run many of the breaking stories on physician ownership/overutilization of physical therapy services in California.

Monday, August 29, 2011

California Struggle Simmers in the Summer

The California struggle between independent physical therapists and physician practices who want to own physical therapists is not over.

The California Medical Association is already working on another legislative action to regain ownership of physical therapy services.

This CMA Alert tells the story from the physicians' standpoint. The physicians are not sitting still. They are working to prevent the California physical therapy board from enforcing the Legislative Council's September 2010 opinion that physical therapists cannot be employed by medical, chiropractic or podiatric corporations.

This struggle is not over. It has only just begun. South Carolina, Washington, Illinois, California have struggled for years to free physical therapists from physician ownership and, hopefully, many other states will soon join the struggle.

The division of labor is the beginning of political differences. Its a natural evolution and it may come only through struggle, sharp elbows and harsh words. That's OK. What physical therapists need now are more practitioners to recognize that this natural process won't advance unless we all get behind and push.

The California private practices still need your help. Donate to help Stop POPTs . Sign their petition. Like them on Facebook.  Call a Senator or a Representative. Tweet.

Let's keep the California struggle simmering this summer.

Saturday, August 27, 2011

Florida Network of Private Practice Physical Therapist Attracts 81 to Orlando Seminar

By all accounts, the First Annual Florida Physical Therapists in Private Practice (FLPTPP) seminar in Orlando was a raging success.

We attracted 81 private practice physical therapists and their office managers to learn about the impact of Medicare Accountable Care Organizations (ACO) on PT private practice.

Our initial projections were 30-40 attendees. Needless to say, the hard work and dedicated effort by the members of the FLPTPP Board of Directors blew those numbers out of the water.

You can see the slideshow of my presentation at the FLPTPP web site.

An active discussion page on the Florida PTPP Facebook page demonstrates with testimonials from enthusiastic physical therapists on the power of networking by member physical therapists.

Stay tuned for updates to the FLPTPP web site for upcoming events.

The expert presenters at this latest seminar included the following:
Our experts have pledged to collaborate with the FLPTPP to provide knowledge sharing in the form of Frequently Asked Questions available to members of the FLPTPP.

Sunday, August 21, 2011

Will ACO Doctors Refer to Private Practice Physical Therapists?

I'm posting tonight from the First Annual Conference of the Florida Physical Therapists in Private Practice in Orlando, Florida where I just gave today's presentation called How Physical Therapists Can Thrive Under Health Care Reform.

The topic centered on Medicare Accountable Care Organizations (ACO) and how physical therapists are well positioned within this changing paradigm to create HEALTH, not just health care.

Some hospitals and ACO administrators, however, just don't get it. They're worried about "leakage" to outpatient physical therapy clinics reducing volume and revenue to fee-for-service hospitals. It's like they think its 1995 again.

According to Kate Fitch, RN, MEd in The Nuts and Bolts of ACOs:
"ACO’s should focus initial medical management efforts on reducing leakage to hospitals and specialists that are not part of the ACO.

This will increase volume to ACO providers and help offset revenue loss due to improved utilization management."
Michael Magidson, Esq describes the "fundamental tension" in the ACO coordinated care model that may limit outside referrals to physical therapists in private practice by ACO administrators concerned about lost revenue and volume.

"Leakage" will concern ACOs who will attempt to limit the patients' choice of providers. Patient choice can be restricted by ACO doctors in two ways:
"You MUST go see the physical therapist I tell you to go to."

The ACO will fail to provide information that patients are free to see any physical therapist even if their doctor is in the ACO.

The Florida Physical Therapists in Private Practice (FLPTPP) is organized to advocate and network for physical therapists in Florida.

Criteria for joining the FLPTPP is at least 51% ownership of your physical therapy clinic and an active physical therapy license in the State of Florida.

Why should physical therapists join the FLPTPP? Knowledge sharing about ACOs and positioning ourselves for the future of health care. Physical therapist private practices will not go away but they will be transformed.

Do you know how ACOs will transform you?

Tuesday, August 16, 2011

The Power of Connecting: How social media is changing healthcare

As consumers we are using social networks to manage just about every aspect of our daily lives. From the way we rate and purchase items to the way we plan our next vacation, we depend on our networks to help us make decisions. We share our lives with others. We seek connection and access. We find value in our networks; they enrich us, expand our knowledge and extend our relationships.

So how are we using these same networks to guide our health and our most important health decisions?

Today patients are participating actively in all aspects of personal health information. Patients are searching for the best knowledge and recommendations to empower themselves for a healthier life.

Many turn to social network groups for support, reassurance and specific health news. A recent article entitled, Healthcare Performance Management in the Era of Twitter discusses how social networks improve patient care by connecting healthcare providers and consumers.

According to the article, 61% of Americans are turning to the Internet for health information, particularly for consumer reviews and comments.

Internet-enabled communities of patients and providers are coming together to communicate and collaborate, explains Brian Klepper, Ph.D., Healthcare Analyst and Consultant, Health 2.0 Advisors. In so doing, these virtual communities are reshaping the way healthcare is delivered and consumed,Ó he says.

Further, a recent Pew Internet Study suggests, The Internet has changed peoples relationship with information. Our data consistently show that doctors, nurses and other health professionals continue to be the first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the U.S.

So how are healthcare providers using social media networks to engage and empower patients? Medical professionals are experimenting with many types of electronic tools to help manage health costs and improve the quality of care. Online social networks offer a unique platform allowing healthcare providers to connect with patients as a larger population. Providers can make recommendations for treatment, comment on the latest medical findings and respond instantly to patient inquiries.

At Sarasota Memorial Hospital in Florida patients tweet their doctor when they have questions about their care. At Chicago's Rush University Medical Center physicians keep connected with patients through Facebook so that they are notified of their recovery. During a real-time brain surgery in March 2009, doctors at Detroit's Henry Ford Hospital answered questions via tweets, broadcasting to more than 1,900 followers.

Other healthcare connector sites include PatientsLikeMe.com where patients can compare care options and outcomes with specialized groups. Sermo and Doximity are web and mobile based social networking platforms where physicians can share insights about medicine and specific cases.

Social media has created new possibilities for patient and provider communication. These tools allow healthcare communities to connect and form support networks that were unimaginable a short time ago. Such networks, in turn, create new platforms for healthcare providers to listen to their patients and provide them with resources to be more accountable. Networks empower recovery and increase the potential for better health outcomes. The power of a network depends on its activity and participation.

Historically, healthcare professionals have been slow to adopt information technology. In 2011, that rate of adoption has accelerated. Healthcare and physical therapy may finally be at a tipping point.

Guest post by Co-authored by Bronwyn Spira, PT, and Mark Fields, PhD, MPH.

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

Saturday, August 13, 2011

Physical Therapists Have Questions about Medicare Accountable Care Organizations (ACO)

First of all let me say that NONE of us are going to figure out the Medicare ACO puzzle alone - we'll each other to share knowledge, network and learn best practices for improving population health.

This is uncharted territory. We're used to treating patients, not populations of (healthy?) people.

Some of the early ACO resources I used are listed here:

The APTA Private Practice Section has two excellent webinars that are available as a free member benefit to PPS members. Go to the APTA Private Practice section website here.

...and click "Health Care Reform" - you will be asked for your APTA-PPS member log-in.

For non-members, the APTA has publicly posted its comments on the Medicare Shared Savings Program.

The APTA is advocating on behalf all practice settings and I was pleased that the ACO Comments addressed concerns of Private Practice Physical Therapists. Particularly, I noticed that the APTA urged CMs to...
"...waive uneccesary and inconsistent Medicare regulations for ACOs including, but not limited to... the requirement for physician signature/certification of the Plan of Care for physical therapy." (page 10)
Finally, a resource that I found helpful was the Dept. Health and Human Services/Center for Medicare/Medicaid Services 10-page primer
Improving Quality of Care for Medicare Patients: Accountable Care Organizations.

Particularly pay attention to the 65 Quality Measures ACOs must meet in order to participate in shared savings - this is where I believe the physical therapist and the physical therapist assistant have the opportunity to shine.

I counted at least 7 of the 65 Quality Measures that are part of the PT/PTA
scope of practice that could improve quality at low cost.

If physical therapists get Direct Access the number of Quality Measures PT/PTAs could impact could rise substantially.

Thursday, August 11, 2011

Physical Therapists' Seminar Presents Professional Medicare Coder

Mary Brown, professional Medicare coder for Kerkering/Barberio in Sarasota, Florida will present Sunday, August 21st at the Florida Physical Therapists in Private Practice (FLPTPP) seminar How Physical Therapists Can Thrive Under Health Care Reform.

Ms. Brown provides clients in the healthcare industry with advisory and compliance assurance services in a variety of practice areas.

Her specialties include:
  • revenue cycle management
  • credentialing with insurance carriers
  • financial reporting
  • operations
  • procedure design and implementation
  • and compliance with third party regulatory requirements.

She has worked with physician specialty groups, laboratories, hospitals and radiology facilities.

Ms Brown joined Kerkering, Barberio & Co. as a Senior Medical Consultant in 2011. Prior to Kerkering, Barberio & Co., she worked for a Sarasota-based medical billing company as the Director of Client Services for 12 years working with both large and small physician groups. Ms Brown graduated from the University of Florida.

Ms Brown is a Certified Professional Coder (CPC) through the American Academy of Professional Coders.

Learn more about Medicare Accountable Care Organizations at the Florida Physical Therapists in Private Practice (FLPTPP) seminar How Physical Therapists Can Thrive Under Healthcare Reforn in Orlando on August 20-21, 2011.

Sign up now for this info-packed seminar at the FLPTPP website.

You can sign up for the 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.

Comparative billing report on outpatient physical therapy services with modifier KX

On Tuesday, August 2, 2011, CMS released a national provider comparative billing report (CBR) centered on independent physical therapy providers who practice in the outpatient setting and bill Medicare with modifier KX.

The CBR is similar to the original study distributed last summer except this current study will focus on 2010 billing data and is being sent to 5000 additional or different providers.

If you participated last year, like I did, you WILL NOT GET a new CBR this year.

The CBRs are produced by Safeguard Services under contract with CMS and contain actual data-driven tables and graphs with an explanation of findings that compare a provider’s billing and payment patterns to those of their peers located in the state and across the nation. CMS has received feedback from a number of providers that this kind of data is very helpful to them and encouraged us to produce more CBRs.

You should use these CBRs to provide in-house training to your physical therapists on how to correctly append the -kx modifier for Medically Necessary physical therapy services.

These reports are not available to anyone but the providers who receive them.

To ensure privacy, CMS presents only summary billing information; no patient or case-specific data is included. These reports are an example of a tool that helps providers comply with Medicare billing rules and improve the level of care they furnish to their Medicare patients.

For more information and to review a sample of the outpatient physical therapy services CBR, please visit the CBR Services website or call the SafeGuard Services’ Provider Help Desk, CBR Support Team at 530-896-7080.

Note: Please go to this link on the First Coast Service Options (FCSO) website .

Wednesday, August 10, 2011

How Physical Therapists Can Add Value to Medicare Accountable Care Organizations

Private practice physical therapists in Florida who understand Medicare Accountable Care Organizations (ACO) are scared about the coming changes in healthcare financing.

But, like many large-scale changes ACOs will bring opportunities for success as well as threats to your current business model.

I'm discussing strengths, weaknesses, opportunities and threats of the ACO model today, August 10th, 2011 at the Florida Health Care Coalition Sixth Annual South Florida Conference Empowering Healthcare/ Engaging Consumers in Ft. Lauderdale, Florida.

Lessons learned here today that physical therapists in private practice can take home:
  • Insurance company employees are patients, too. They want better access, process and outcomes of care than they are getting now.
  • Wellness and Coaching are proven, albeit expensive, alternative model of chronic care delivery. "Expensive" is relative to the cost of people just taking care of themselves though better diet, exercise and controlling addictive or compulsive behaviors.
  • Improving behavior is also a proven strategy to lower costs. Whose behavior needs controlling? Patients need better strategies for managing their personal behaviors. Providers need more accountability for our workplace behaviors.
  • Behavior change skills are fundamentally different from physical therapists' traditional focus on "patient education".
  • Primary care physicians will be reimbursed for providing wellness care (eg: exercise prescriptions and interventions).
  • There is a problem with "rouge specialty physicians" driving up costs by performing too many uneccessary procedures, especially in South Florida.
  • A short-term cost saving strategy will be to increase screening of healthy populations for high-cost, common conditions, like future falls risk in elderly people, comunity-acquired pneumonia and depression in post-surgical patients.

    Physical therapists can provide these screenings.
  • Some insurance companies are experimenting with influencing patient behavior using social media, like Facebook and Twitter.

Learn more about Medicare Accountable Care Organizations at the FLorida Physical Therapists in Private Practice (FLPTPP) seminar How Physical Therapists Can Thrive Under Healthcare Reforn in Orlando on August 20-21, 2011.

Sign up now at the FLPTPP website.

You can sign up for the 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.

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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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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.