Value Centered Physical Therapy

This post comes from a thread in the Yahoo Groups PT Manager listserve between Rick Gawenda, APTA Adminstration Section President and Larry Benz, PT of MyPhysicalTherapySpace.com which discusses the perception that commercial insurance companies like UnitedHealthGroup are trying to emulate Medicare.

This is seen as bad by many physical therapists since Medicare is the most restrictive payer from the notes and charts compliance standpoint.

Medicare also has police powers. That is, if you mess up they may put you in jail.

If there is an organized attempt to model commercial insurance after Medicare then that is news to me.

But, come to think of it - why not?

If we hold Medicare as the standard-setting authority (since professional consensus and practice guidelines don't have any teeth) then could physical therapists follow just one standard?

Can we reduce the goals of the Medicare Manuals (like Transmittal 88) to their intended essence?

The more simple the interpretation of Medicare regulation the easier will be physical therapist compliance and the better will be patient care.

Correct me if I'm wrong (and I'm sure you will) but the Medicare Manuals (and their cousins the Local Coverage Determinations) are aimed at producing three things:

1) that physical therapists demonstrate the medical necessity of physical therapy in their charts and notes.

2) that physical therapists demonstrate that each intervention billed is skilled.

3) that the patient is expected to show significant improvement in measurable function as a result of the physical therapy.

Reimbursement aside, these criteria make for good physical therapy!

If student physical therapists (and old-school professionals) were trained to treat patients with these three criteria in mind then everybody would benefit.

- therapists would benefit from reduced documentation burden (drop the SOAP!)

- therapists managers and administrators would benefit from fewer regulatory constraints by following one standard.

- patients would benefit by increasing focus on measurable function and fewer symptom-oriented and pathology-oriented treatments.

- insurance companies (including Medicare) would benefit from greater transparency in physical therapy charts and notes.

When I graduated in 1992 from the University of Florida I had no training in the disablement model, in physical therapy diagnosis or in describing the medical necessity for physical therapy.

I thought the physician determined medical necessity! (maybe in 1992 they did).

Anyways, it's high time we standardized the 'rules of the road' for physical therapists and physical therapy managers.

If anyone is keeping score then they can count my vote for regulatory standards in physical therapy.