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.