Show medical necessity for Medicare physical therapy patients using walking speed as part of your clinic's compliance plan.
When over 40% of all Medicare
claim denials are based on Medically (un)Necessary physical therapy and when SO many people need physical therapy it seems apparent that we need quick, simple tools like walking speed to assess who needs (and who doesn't need) physical therapy.Stacy Fritz, PT, PhD and Michelle Lusardi, PT, PhD recently published Walking Speed: the Sixth Vital Sign in the Journal of Geriatric Physical Therapy.
It seems that Drs. Fritz and Lusardi's tool couldn't have come at a better time.
The current administration is trying to create 'value' in the health care marketplace. Value is typically described as...
Value = Quality / Cost
- I define quality as the best possible functional outcome for my patient.
- A surgeon might define quality as an x-ray showing bony fusion.
- An insurance company might define quality as fewer PT visits or fewer MRI scans per episode of care.
- The federal government might define quality as a 'public option' that covers 100% of Americans with a basic basket of health care services.
"...to develop payment method alternatives to the current financial cap on outpatient therapy services."Yet these partnerships promise to deliver fruit in no less than five years! You and I can't wait that long - your patients can't wait that long.
Dog Days
As the summer winds down and the second half of 2009 rolls around you will start to see more and more patients who have hit their annual, per beneficiary financial limit (the therapy cap).
How will you justify your services?
In my town, the largest provider of outpatient physical therapy services has a blanket policy...
When the patient hits the $1,840 Medicare cap for PT services they are discharged - no audit risk here!Unfortunately, our health care market incentivizes physical therapists to deny needed services to eligible patients based on audit risk to the physical therapist.
I Love my Country but I Fear My Government!
Physical therapists need predictive tools that we can hang our hats on when recommending continued therapy for patients over the cap.
Walking speed is also helpful at the evaluation since the physician cannot determine medical necessity for the initial plan of care - that's the job of the PT.
That comes as a surprise to many physical therapists - making accountable decisions is a responsibility many of us are not ready for.
Well, get ready. Walking speed is a new tool that will help you show need and progress if your patient exceeds the $1,840 cap.
Physical therapists shouldn't feel bad
Chiropractors are no better at determining medical necessity and showing functional progress.
47% of chiropractic claims were paid by Medicare in error. Chiropractors should use Fritz' walking speed bar graph to show need and progress for their Medicare patients.
Walking speed measurements are quick, inexpensive and effective. We have no reason not to use them.
Special thanks to Selena Horner, PT blogging at MyPhysicalTherapySpace.com .
