Guest guest Posted August 16, 2011 Report Share Posted August 16, 2011 If the service is not provided by a PT or a PTA then it is not skilled treatment, therefore non-billable. The code 97110 is a skilled PT service. Edilia Gualdron, DPT > > Can anyone tell me if they use PT Aides/Techs to perform supervised > exercises, by the PT of course, and code 97110 on a regular scheduled > basis? We are just trying to cut our cost/visit due to MPPR and other > unfavorable market conditions. > > We are planning on using a PT Aide after manual therapy and other > skilled services are applied by a PT so to increase volume on the > schedule and still continuing coding after the PT is done with the > patient. > > Does insurance (Medicare, etc) have any objections to this even if > they are supervised? > > Hankins, PT > Synergy Therapies, LLC > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2011 Report Share Posted August 16, 2011 If the service is not provided by a PT or a PTA then it is not skilled treatment, therefore non-billable. The code 97110 is a skilled PT service. Edilia Gualdron, DPT > > Can anyone tell me if they use PT Aides/Techs to perform supervised > exercises, by the PT of course, and code 97110 on a regular scheduled > basis? We are just trying to cut our cost/visit due to MPPR and other > unfavorable market conditions. > > We are planning on using a PT Aide after manual therapy and other > skilled services are applied by a PT so to increase volume on the > schedule and still continuing coding after the PT is done with the > patient. > > Does insurance (Medicare, etc) have any objections to this even if > they are supervised? > > Hankins, PT > Synergy Therapies, LLC > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2011 Report Share Posted August 16, 2011 If the service is not provided by a PT or a PTA then it is not skilled treatment, therefore non-billable. The code 97110 is a skilled PT service. Edilia Gualdron, DPT > > Can anyone tell me if they use PT Aides/Techs to perform supervised > exercises, by the PT of course, and code 97110 on a regular scheduled > basis? We are just trying to cut our cost/visit due to MPPR and other > unfavorable market conditions. > > We are planning on using a PT Aide after manual therapy and other > skilled services are applied by a PT so to increase volume on the > schedule and still continuing coding after the PT is done with the > patient. > > Does insurance (Medicare, etc) have any objections to this even if > they are supervised? > > Hankins, PT > Synergy Therapies, LLC > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2011 Report Share Posted August 16, 2011 , Medicare (and usually state Medicaid) absolutely will not reimburse for treatment done by support personnel. For other insurances, they may(you'll have to check each contract) but then it depends on what is allowed by practice act. Many states practice acts also prevent support personnel from doing treatment tasks so make sure you know what your state practice act says. There are plenty of other ways to cut costs. Consider a consultant to help with that but some ways include improving your front office efficiency to free up licensed staff to spend more time in billable time and less with non-billables (ie making sure your staff is fully productive), improve your billing efficiency and making sure staff is billing correctly, look at your benefit structure and restructure it, cut anywhere you can with overhead and so on. Contact me directly if you want or if you have any additional questions. M. Howell, PT, MPT Howell Physical Therapy Eagle, ID thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. From: PTManager [mailto:PTManager ] On Behalf Of scott hankins Sent: Tuesday, August 16, 2011 5:33 PM To: PTManager Subject: PT Aides and 97110 Can anyone tell me if they use PT Aides/Techs to perform supervised exercises, by the PT of course, and code 97110 on a regular scheduled basis? We are just trying to cut our cost/visit due to MPPR and other unfavorable market conditions. We are planning on using a PT Aide after manual therapy and other skilled services are applied by a PT so to increase volume on the schedule and still continuing coding after the PT is done with the patient. Does insurance (Medicare, etc) have any objections to this even if they are supervised? Hankins, PT Synergy Therapies, LLC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 16, 2011 Report Share Posted August 16, 2011 To add to Edilia's correct response: If the service could be performed by an aide, it is unskilled *even if performed by a PT or PTA*. (Watching a patient perform his exercises is not skilled treatment.) This might be an opportunity for cash-based business, if your patient would want to pay to stay and use your equipment (with the help/supervision of your aide) after his treatment session is completed. Diane , PT Augusta, GA On Tue, Aug 16, 2011 at 10:34 PM, Edilia Gualdron < ediliagualdronpt@...> wrote: > ** > > > If the service is not provided by a PT or a PTA then it is not skilled > treatment, therefore non-billable. The code 97110 is a skilled PT service. > Edilia Gualdron, DPT > > > > > > Can anyone tell me if they use PT Aides/Techs to perform supervised > > exercises, by the PT of course, and code 97110 on a regular scheduled > > basis? We are just trying to cut our cost/visit due to MPPR and other > > unfavorable market conditions. > > > > We are planning on using a PT Aide after manual therapy and other > > skilled services are applied by a PT so to increase volume on the > > schedule and still continuing coding after the PT is done with the > > patient. > > > > Does insurance (Medicare, etc) have any objections to this even if > > they are supervised? > > > > Hankins, PT > > Synergy Therapies, LLC > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 If you are providing skilled interventions, you should be using licensed hands. Many states allow for therapy techs and aides to perform tasks that they are competent in performing, however billing for skilled therapy , those interventions that require the knowledge of a therapist and the skills to perform and monitor, should be administered by a PT , PTA. I do know some will disagree with this statement. Medicare does not pay for therapy provided by a non licensed technician Ron Barbato PT Administrative Director, Rehabilitation Services Program Director, Cancer Support Services Ephraim McDowell Health PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. PT Aides and 97110 Can anyone tell me if they use PT Aides/Techs to perform supervised exercises, by the PT of course, and code 97110 on a regular scheduled basis? We are just trying to cut our cost/visit due to MPPR and other unfavorable market conditions. We are planning on using a PT Aide after manual therapy and other skilled services are applied by a PT so to increase volume on the schedule and still continuing coding after the PT is done with the patient. Does insurance (Medicare, etc) have any objections to this even if they are supervised? Hankins, PT Synergy Therapies, LLC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Aides Use or not use, which is the question. Ever since I first began following PTManager on this list serve, the concepts of productivity and use of extenders has been a strong topic for discussion. The contributions to the list serve on this topic usually fall into one of two categories. However, the crux of the issue is money; how to make as much as possible with the staffing and patient mix in your particular clinic. On the list serve I have observed the semantics and rationalizations by both sides of the issue. However, I never have seen anyone come out and say, “I use techs and or aides so I can do more than one patient at a time”. You know this is the reason. I know this is the reason. I have seen arguments stating that the government should not be telling me how I should run my practice. One argument being that “I deserve 100% autonomy and use my clinical outcomes to make my case for whether I can see more than one patient at a time” . The other side will argue that unless a PT or PTA delivers the service it is not skilled. Others state that it is the level of complexity that determines the criteria or whether or not it is skilled. I have patients report frequently, that they only see the therapist one time, are handed a set of exercises along with a timer, then shepherded to the gym where the patient reports being watched by a aide. The patient explains that the therapist goes away, many times to wave at them from across the room while working with another patient, sometimes never to return. Unfortunately the patient does not have knowledge of one on one codes, what skilled therapy means, nor any ideas of the 8 minute rules. The patient rarely complains about this, they simply do not return. Other times I have patient report wonderful therapists that took the time to do the manual work needed to restore function and decrease pain while describing their therapists as one that took the time to explain “the why” as well as “the what” of diagnosises that they needed to be understanding. The bottom line to my long winded diatribe is that as therapist we all know what the definitions of the codes are meant to be. One on one means one on one. Skilled means skilled. Group means group. Supervised means supervised. You can rationalize as much as you want, but the meanings do not change. The only reason to go outside of the definitions would be (simply put) to increase profit, make more money, improve your financial bottom line. I may be a one man band singing this song, but I doubt it. Steve Marcum PT Outpatient Physical Therapy Lexington, KY, 40517 -- “Anyone who lives a sedentary life and does not exercise, even if he eats good foods and takes care of himself according to proper medical principles, all his days will be painful ones and his strength shall wane.” Maimonides, 1199 AD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Steve, Make it a duo at least. Nice post. I just had a patient today tell me how she made more progress in two weeks with me than in SEVEN MONTHS at another facility. And we wonderful why we get flack from insurance companies (although I am certainly no insurance company apologist). All the time, I see and hear PTs talking about marketing strategies, advertising, etc. yet they'll operate in a way that is self-sabotaging both to themselves and to their profession. If your work is good, you don't need much of a marketing strategy or advertising or iPad gimmicks or high tech machinery that evolves into overpriced coat hangers. My first practice was built on ONE patient. I saw him. He sent his wife, his children, his mother, his father, relatives, employees, business associates, friends, acquaintances, etc., and so on and so on. If your work is good, it speaks for itself. , PT, OCS RE: PT Aides and 97110 Aides Use or not use, which is the question. Ever since I first began following PTManager on this list serve, the concepts of productivity and use of extenders has been a strong topic for discussion. The contributions to the list serve on this topic usually fall into one of two categories. However, the crux of the issue is money; how to make as much as possible with the staffing and patient mix in your particular clinic. On the list serve I have observed the semantics and rationalizations by both sides of the issue. However, I never have seen anyone come out and say, " I use techs and or aides so I can do more than one patient at a time " . You know this is the reason. I know this is the reason. I have seen arguments stating that the government should not be telling me how I should run my practice. One argument being that " I deserve 100% autonomy and use my clinical outcomes to make my case for whether I can see more than one patient at a time " . The other side will argue that unless a PT or PTA delivers the service it is not skilled. Others state that it is the level of complexity that determines the criteria or whether or not it is skilled. I have patients report frequently, that they only see the therapist one time, are handed a set of exercises along with a timer, then shepherded to the gym where the patient reports being watched by a aide. The patient explains that the therapist goes away, many times to wave at them from across the room while working with another patient, sometimes never to return. Unfortunately the patient does not have knowledge of one on one codes, what skilled therapy means, nor any ideas of the 8 minute rules. The patient rarely complains about this, they simply do not return. Other times I have patient report wonderful therapists that took the time to do the manual work needed to restore function and decrease pain while describing their therapists as one that took the time to explain " the why " as well as " the what " of diagnosises that they needed to be understanding. The bottom line to my long winded diatribe is that as therapist we all know what the definitions of the codes are meant to be. One on one means one on one. Skilled means skilled. Group means group. Supervised means supervised. You can rationalize as much as you want, but the meanings do not change. The only reason to go outside of the definitions would be (simply put) to increase profit, make more money, improve your financial bottom line. I may be a one man band singing this song, but I doubt it. Steve Marcum PT Outpatient Physical Therapy Lexington, KY, 40517 -- " Anyone who lives a sedentary life and does not exercise, even if he eats good foods and takes care of himself according to proper medical principles, all his days will be painful ones and his strength shall wane. " Maimonides, 1199 AD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 Don't worry Steve. Some of us totally agree with you. That said, I think it is good that the APTA, thanks to the RC pushed through by the Private Practice section, is going to re-evaluate their position on the use of support personnel. I will be very interested in what the task force decides. I do think, in light of the pressures of treatment and the fact that payment policies aren't changing much, we do have to look at practice in terms of what it takes to survive. I hate to think this but: All our competitors use support personnel for treatment and get paid for it. If we as a profession, supply research (which is what I have been asking for, for ages now) to show that the selected use of support personnel, as delegated by the PT, is safe, effective AND should be reimbursed at the same rate as a PT, then why shouldn't we try? The trick, when considering the RC, is how is our profession going to convince an insurance company to pay for services provided by support personnel at the same rate as the PT?? One hope is that treatment tasks done safely (by the research) by support personnel will be additional revenue that would normally not be captured. Again, good luck trying to get insurances to pay. Look at it the way the RC was asking as well: if a physician is respected enough to use " incident to " services, under their supervision AND get paid for it, then why shouldn't we? I don't know the answer to that. That is the task force's job to do but I think it will all be a very difficult thing for insurances to understand or agree to. One area under support personnel that I agree needs to be addressed is a well-educated and qualified ATC or exercise physiologist being kept at the level of an aide. We need to have some way to license them to respect their training so they can bill on par with the PTA. The risk still remains that the more we continue to use non-licensed personnel for treatment or non-PT providers for treatment, the more insurances and the healthcare system will ask " Why do we need PT's? " I think that is a serious concern that I hope that task force addresses as well. Tom thowell@... This email and any files transmitted with it may contain PRIVILEGED or CONFIDENTIAL information and may be read or used only by the intended recipient. If you are not the intended recipient of the email or any of its attachments, please be advised that you have received this email in error and that any use, dissemination, distribution, forwarding, printing or copying of this email or any attached files is strictly prohibited. If you have received this email in error, please immediately purge it and all attachments and notify the sender by reply email. RE: PT Aides and 97110 Aides Use or not use, which is the question. Ever since I first began following PTManager on this list serve, the concepts of productivity and use of extenders has been a strong topic for discussion. The contributions to the list serve on this topic usually fall into one of two categories. However, the crux of the issue is money; how to make as much as possible with the staffing and patient mix in your particular clinic. On the list serve I have observed the semantics and rationalizations by both sides of the issue. However, I never have seen anyone come out and say, " I use techs and or aides so I can do more than one patient at a time " . You know this is the reason. I know this is the reason. I have seen arguments stating that the government should not be telling me how I should run my practice. One argument being that " I deserve 100% autonomy and use my clinical outcomes to make my case for whether I can see more than one patient at a time " . The other side will argue that unless a PT or PTA delivers the service it is not skilled. Others state that it is the level of complexity that determines the criteria or whether or not it is skilled. I have patients report frequently, that they only see the therapist one time, are handed a set of exercises along with a timer, then shepherded to the gym where the patient reports being watched by a aide. The patient explains that the therapist goes away, many times to wave at them from across the room while working with another patient, sometimes never to return. Unfortunately the patient does not have knowledge of one on one codes, what skilled therapy means, nor any ideas of the 8 minute rules. The patient rarely complains about this, they simply do not return. Other times I have patient report wonderful therapists that took the time to do the manual work needed to restore function and decrease pain while describing their therapists as one that took the time to explain " the why " as well as " the what " of diagnosises that they needed to be understanding. The bottom line to my long winded diatribe is that as therapist we all know what the definitions of the codes are meant to be. One on one means one on one. Skilled means skilled. Group means group. Supervised means supervised. You can rationalize as much as you want, but the meanings do not change. The only reason to go outside of the definitions would be (simply put) to increase profit, make more money, improve your financial bottom line. I may be a one man band singing this song, but I doubt it. Steve Marcum PT Outpatient Physical Therapy Lexington, KY, 40517 -- " Anyone who lives a sedentary life and does not exercise, even if he eats good foods and takes care of himself according to proper medical principles, all his days will be painful ones and his strength shall wane. " Maimonides, 1199 AD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2011 Report Share Posted August 17, 2011 What is the skill? Is the skill assessing the patient and developing the plan of care? Is the skill the PT deciding the patient needs ultrasound to address their impairments or is it moving the sound head over the area for the allotted time to achieve the desired outcome? Does it take a therapist or assistant to do an ultrasound, set up a patient on unattended e-stim or mechanical traction? Isn't the " skill " the assessment of the patient by the therapist at the start of each TX session to determine what the patient needs that TX session and who is best to provide that service? Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. www.gawendaseminars.com Register for Documenting Therapy Services for Medical Review at http://www.gawendaseminars.com/news.aspx > > Subject: RE: PT Aides and 97110 > To: PTManager > Date: Wednesday, August 17, 2011, 2:34 PM > Aides Use or not use, which is the > question. > > Ever since I first began following PTManager on this list > serve, the > concepts of productivity and use of extenders has been a > strong topic for > discussion. The contributions to the list serve on > this topic usually fall > into one of two categories. However, the crux of the > issue is money; how to > make as much as possible with the staffing and patient mix > in your > particular clinic. > > On the list serve I have observed the semantics and > rationalizations by both > sides of the issue. However, I never have seen anyone > come out and say, “I > use techs and or aides so I can do more than one patient at > a timeâ€. You > know this is the reason. I know this is the reason. > > I have seen arguments stating that the government should > not be telling me > how I should run my practice. One argument being that > “I deserve 100% > autonomy and use my clinical outcomes to make my case for > whether I can see > more than one patient at a time†. The other side > will argue that unless a > PT or PTA delivers the service it is not skilled. > Others state that it is > the level of complexity that determines the criteria or > whether or not it is > skilled. > > I have patients report frequently, that they only see the > therapist one > time, are handed a set of exercises along with a timer, > then shepherded to > the gym where the patient reports being watched by a > aide. The patient > explains that the therapist goes away, many times to wave > at them from > across the room while working with another patient, > sometimes never to > return. Unfortunately the patient does not have > knowledge of one on one > codes, what skilled therapy means, nor any ideas of the 8 > minute rules. The > patient rarely complains about this, they simply do not > return. > > Other times I have patient report wonderful therapists that > took the time to > do the manual work needed to restore function and decrease > pain while > describing their therapists as one that took the time to > explain “the why†> as well as “the what†of diagnosises that they needed > to be understanding. > > The bottom line to my long winded diatribe is that as > therapist we all know > what the definitions of the codes are meant to be. > One on one means one on > one. Skilled means skilled. Group means > group. Supervised means > supervised. You can rationalize as much as you want, > but the meanings do > not change. The only reason to go outside of the > definitions would be > (simply put) to increase profit, make more money, improve > your financial > bottom line. > > I may be a one man band singing this song, but I doubt it. > > Steve Marcum PT > > Outpatient Physical Therapy > > Lexington, KY, 40517 > > > -- > “Anyone who lives a sedentary life and does not exercise, > even if he eats > good foods and takes care of himself according to proper > medical principles, > all his days will be painful ones and his strength shall > wane.†> Maimonides, 1199 AD > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 Your assumption is that the PT will be readily available and " see " each patient prior to treatment. You and I know this will not be the case in all situations. In that scenario the patient is at risk Yes it does take the skill of a PT to assess and discern a POC, and yes it does take skill of a PT to determine response to treatment and adjust , make changes as needed. If it were just about doing an US or performing exercise, We( PT) would not be needed. Ron Barbato PT PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. RE: PT Aides and 97110 > To: PTManager > Date: Wednesday, August 17, 2011, 2:34 PM > Aides Use or not use, which is the > question. > > Ever since I first began following PTManager on this list > serve, the > concepts of productivity and use of extenders has been a > strong topic for > discussion. The contributions to the list serve on > this topic usually fall > into one of two categories. However, the crux of the > issue is money; how to > make as much as possible with the staffing and patient mix > in your > particular clinic. > > On the list serve I have observed the semantics and > rationalizations by both > sides of the issue. However, I never have seen anyone > come out and say, " I > use techs and or aides so I can do more than one patient at > a time " . You > know this is the reason. I know this is the reason. > > I have seen arguments stating that the government should > not be telling me > how I should run my practice. One argument being that > " I deserve 100% > autonomy and use my clinical outcomes to make my case for > whether I can see > more than one patient at a time " . The other side > will argue that unless a > PT or PTA delivers the service it is not skilled. > Others state that it is > the level of complexity that determines the criteria or > whether or not it is > skilled. > > I have patients report frequently, that they only see the > therapist one > time, are handed a set of exercises along with a timer, > then shepherded to > the gym where the patient reports being watched by a > aide. The patient > explains that the therapist goes away, many times to wave > at them from > across the room while working with another patient, > sometimes never to > return. Unfortunately the patient does not have > knowledge of one on one > codes, what skilled therapy means, nor any ideas of the 8 > minute rules. The > patient rarely complains about this, they simply do not > return. > > Other times I have patient report wonderful therapists that > took the time to > do the manual work needed to restore function and decrease > pain while > describing their therapists as one that took the time to > explain " the why " > as well as " the what " of diagnosises that they needed > to be understanding. > > The bottom line to my long winded diatribe is that as > therapist we all know > what the definitions of the codes are meant to be. > One on one means one on > one. Skilled means skilled. Group means > group. Supervised means > supervised. You can rationalize as much as you want, > but the meanings do > not change. The only reason to go outside of the > definitions would be > (simply put) to increase profit, make more money, improve > your financial > bottom line. > > I may be a one man band singing this song, but I doubt it. > > Steve Marcum PT > > Outpatient Physical Therapy > > Lexington, KY, 40517 > > > -- > " Anyone who lives a sedentary life and does not exercise, > even if he eats > good foods and takes care of himself according to proper > medical principles, > all his days will be painful ones and his strength shall > wane. " > Maimonides, 1199 AD > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 Since I started this very enlightening and productive " conversation " , I want to chime in and give my 2 cents worth.  PT aides/techs are being used today for various reasons. They clean, file paperwork, apply hot/cold packs, get a modality cart, maybe apply the modality on a patient, stand by a patient for safety reasons during exercise, be a " voicepiece " for the PT during a pt exercise regimen when the PT is doing manual therapy on the other side of the gym or because the PT has to step out to take a phone call; well you get the point.  There is no standardization for the job of being a PT aide! No common job description for a PT aide, like there is for PT's and PTA's.  We know what they can't do and that is provide skilled PT interventions because they are not schooled and licensed to be a PT. I get that!  So during a busy day when volume is high on everyones schedule (PT and PTA alike) so the private practice clinic can make a meager profit (even with well controlled expenses and cash pay services and decent payor mix) or just to pay the bills in a reduced reimbursement era, the staff needs help from a PT aide to keep the place moving smoothly and might have to help with patient care AT TIMES. Not provide skilled care, but to help the PT or PTA under their supervision.  Now under this supervised care, does the PT code for services this PT aide, " aided " , him or her with under their supervision?  If I am doing a Maitland mob on a LBP pt, while supervising (line of sight thing) my PT aide helping a pt do a bilateral squat w/o falling, all the while I am barking out orders to make sure they are not taking their knees beyond their toes, what do I do? Not code a 97110, or 97150 if it is a Medicare pt, because the PT aide is standing by the pt for safety purposes? I know I would not code it if I left for 15 min to make a phone call and never watched the pt and PT aide interact. That is not skilled. But if I am there in the same room as that PT aide and pt while providing care to another pt, then I have a hard time seeing that as not a skilled service, and not reimburseable. Especially if I evaluated the pt, know what's good for them as far what skilled interventions to use, and allow the PT aide, to aide me, in getting a pt through their visit safely, I would say that is skilled care. It was my idea to do the squat exercise, my skilled mind, making that happen, not the PT aides mind.  I believe we as PTs should use judgement when coding so to honor and uphold the spirit and integrity of what the code is designed to be used for. To represent the skilled interventions we do a darn good job at when we take our profession serious.  We as PT clinic owners should only hire those people who make our profession noble, filled with integrity, and respected. We should hire PTs, PTAs, AND PT Aides/techs that help the clinic provide the best skilled therapy possible and get paid a reasonable amount for it, with a good margins, so I can eat some good steak every once in a while, take my wonderful family to Disney World, and retire before I am 85!  THOUGHTS???  Hankins, PT Synergy Therapies, LLC To: PTManager Sent: Thursday, August 18, 2011 1:59 PM Subject: RE: PT Aides and 97110  Your assumption is that the PT will be readily available and " see " each patient prior to treatment. You and I know this will not be the case in all situations. In that scenario the patient is at risk Yes it does take the skill of a PT to assess and discern a POC, and yes it does take skill of a PT to determine response to treatment and adjust , make changes as needed. If it were just about doing an US or performing exercise, We( PT) would not be needed. Ron Barbato PT PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that is privileged subject to attorney-client privilege or attorney work product, confidential and/or exempt from disclosure under applicable law. If you are not the intended recipient, then please do not read it and be aware that any disclosure, copying, distribution, or use of the information contained herein (including any reliance thereon) is STRICTLY PROHIBITED. If you received this transmission in error, please immediately advise me, by reply e-mail, and delete this message and any attachments without retaining a copy in any form. Thank you. RE: PT Aides and 97110 > To: PTManager > Date: Wednesday, August 17, 2011, 2:34 PM > Aides Use or not use, which is the > question. > > Ever since I first began following PTManager on this list > serve, the > concepts of productivity and use of extenders has been a > strong topic for > discussion. The contributions to the list serve on > this topic usually fall > into one of two categories. However, the crux of the > issue is money; how to > make as much as possible with the staffing and patient mix > in your > particular clinic. > > On the list serve I have observed the semantics and > rationalizations by both > sides of the issue. However, I never have seen anyone > come out and say, " I > use techs and or aides so I can do more than one patient at > a time " . You > know this is the reason. I know this is the reason. > > I have seen arguments stating that the government should > not be telling me > how I should run my practice. One argument being that > " I deserve 100% > autonomy and use my clinical outcomes to make my case for > whether I can see > more than one patient at a time " . The other side > will argue that unless a > PT or PTA delivers the service it is not skilled. > Others state that it is > the level of complexity that determines the criteria or > whether or not it is > skilled. > > I have patients report frequently, that they only see the > therapist one > time, are handed a set of exercises along with a timer, > then shepherded to > the gym where the patient reports being watched by a > aide. The patient > explains that the therapist goes away, many times to wave > at them from > across the room while working with another patient, > sometimes never to > return. Unfortunately the patient does not have > knowledge of one on one > codes, what skilled therapy means, nor any ideas of the 8 > minute rules. The > patient rarely complains about this, they simply do not > return. > > Other times I have patient report wonderful therapists that > took the time to > do the manual work needed to restore function and decrease > pain while > describing their therapists as one that took the time to > explain " the why " > as well as " the what " of diagnosises that they needed > to be understanding. > > The bottom line to my long winded diatribe is that as > therapist we all know > what the definitions of the codes are meant to be. > One on one means one on > one. Skilled means skilled. Group means > group. Supervised means > supervised. You can rationalize as much as you want, > but the meanings do > not change. The only reason to go outside of the > definitions would be > (simply put) to increase profit, make more money, improve > your financial > bottom line. > > I may be a one man band singing this song, but I doubt it. > > Steve Marcum PT > > Outpatient Physical Therapy > > Lexington, KY, 40517 > > > -- > " Anyone who lives a sedentary life and does not exercise, > even if he eats > good foods and takes care of himself according to proper > medical principles, > all his days will be painful ones and his strength shall > wane. " > Maimonides, 1199 AD > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 To Mr. Anonymous, PT  Who ever you are that just posted this, I want to stand up and raise my glass to you! With goosebumps-a-poppin, your voice of reason and passion hit a courd with me and I'm sure the other private practice owners who rose from a slumber of one on one monotonous care, all the while collecting a sleepy $5-10 bucks a visit.  We do not want to get wealthy, not eat squid on pretentious yacht, just eat steak with the fam on vacation knowing I am doing something noble while making a good American life. The American Dream is just that, a Dream! Not a reality. No matter how many clinics you cash flowed, you should be doing better, legally!  So once again, we have stated the problem with boldness Mr. Anonymous, PT, now what is the answer? How do we fight for justifiable margins, while applying our DPT, PT, RPT, OCS, COMT, FAAOMPT, ART, LMNOP expertise as owners of PT clinics that " rock it out " in measured quality.  I am all ears! I have my ideas. I have called the insurance companies, state board, talked to the APTA, and insurance commissions, and got the same answers - " Just email me your question, what specific scenarios you are referring to in pt care, and we will review it with the Board " . *#$% the Board, they will only give you a company line, interpreting " gray " areas in the contract, like what constitutes quality, supervision, PT aide use, one on one care, etc, that serves their bottom line or what they feel is ethical and quality. Hey what about my bottom line, you drop my $ by 5% +, then I drop you by 100%.  Yes we can go with those many efficiency models to make a penny or nickel more, but come on, we all know, in private practice, we should make an honest living doing what we do best, be a PT, without NEEDING to supplement our profits or income with weekend work or cash pay gym services.  Come on people, let's hear some more productive, maybe less emotional ideas (sorry), about our worth, how to make greater margins and how to be ethical in all we do. Hey first, let's define ethical. That might be a good start. Then we can get a good idea of whether one on one, two on one, proper use of ancillary staff (PT aides), manual vs exercise, etc is quality.  Hankins, PT Synergy Therapies, LLC  To: PTManager Sent: Thursday, August 18, 2011 7:03 PM Subject: PT Aides and 97110  Posted on behalf of a PTManager who does not want to be ID'd *************************************************************************** Thanks Rick and others, The focus on one on one care is killing our profession and will be the final nail in the coffin of our profession. Is it a skilled activity to have a PT or PTA stand by grandma and count her reps so you can bill 97110 rather than group? The PT determined the need for the activity, set the parameters of the exercise and fully observes it's set up by a (you fill in the blank). We all hear, and repeat, how great we are but that clinic down the street doesn't spend time with the patient, blah, blah, blah. Remember the knife cuts both ways. For the respondents to this post and others in a similar vein I have a few questions: Do you collect objective, standardized, risk adjusted outcomes as well as patient satisfaction data? Justify your " quality of care " with data, if you can't the rest is just hot air. Time does not equal quality or ethics. What about the OP clinics where the PT is there on a Monday doing evaluations and PTA co-visits for the week not to return till the following Monday to do it all over again. Who is making the program changes, progressions, modifications when the PT is not on site for the remainder of the week? On the other hand the OP clinic with a full time PT/owner, onsite 50 hours/week, with an aide or two. This PT is in constant contact with knowledge of what each patient's status and makes program changes daily. My heart goes out to the younger PT's that have huge student loans with expectations of big salaries. My heart also goes out to the facilities whose individual PT productivity doesn't " cover their nut " , " you want me to see >10 visits/day and do an eval but what about the ethical one on one care? " Time does not equal quality or ethics. The tipping point that our profession will be a loss leader when health care contracts are signed is close at hand. Meanwhile, EP and ATC's do " functional testing " for cash with less training quoting PT research to justify their conclusions. What do we do, " hey they can't do that " . Yet these groups also get referrals from physicians for post op " rehab " at your local gym. Why? Simple answer, many of us are too passive with our interventions. What do we do as PTs? Complain and cry foul but are unwilling to consider alternative practice settings or adding these skills to our tool box. Quoting Norm from the old TV show CHEERS. " its a dog eat dog world out their and I'm wearing milk bone shorts " . We are wearing the shorts and giving away more milk bones. When are we going to turn around and take on the dogs? The leaders of our profession have put us into the " one on one treatment " box which is completely unsustainable. Now its a mantra tied to quality and ethics. Time does not equal quality or ethics. State boards are there to police the fraud, overutilization, and improper care issues so let them. As a profession we need to raise our productivity, and consider alternative practice settings to meet the needs of the consumer and market place, or lower our expectations of pay and benefits. There are other groups out there more than willing to step in for PT. Profit is not a bad thing but is hard to justify the hours and stress for 6%. , I would ask that you withhold my name and email from this post. As a fellow private practice clinician/owner in the killing fields day in and day out for the past 20 years I feel that I am jousting with windmills some days. If you can not withhold I understand, then do not post. We are far too passive as a profession. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 To the therapist who wishes to remain anonymous, Your quote, " The leaders of our profession have put us into the " one on one treatment " box which is completely unsustainable " is not entirely accurate. It is the AMA who has put us into the one-to-one treatment box to which you refer. The AMA defines our billable services (one-to-one and group treatment) in the CPT manual. The leaders of our profession should not to blamed for these restrictive definitions. How we provide and delegate the delivery of these billable services is defined by our state practice act and the contractual agreements we accept. If we disagree with our state practice act, we should lobby to get the rules changed. If we disagree with the restrictions set forth in a contractual agreement, we should opt out and not sign it. Are we not free to pursue alternative practice settings to meet the needs of the consumer as ATCs and EPs do? Our " PT leadership " does not prohibit this. Jon Mark Pleasant, PT > > Posted on behalf of a PTManager who does not want to be ID'd > *************************************************************************** > > > Thanks Rick and others, > > The focus on one on one care is killing our profession and will be the final > nail in the coffin of our profession. > > Is it a skilled activity to have a PT or PTA stand by grandma and count her reps > so you can bill 97110 rather than group? The PT determined the need for the > activity, set the parameters of the exercise and fully observes it's set up by a > (you fill in the blank). > > We all hear, and repeat, how great we are but that clinic down the street > doesn't spend time with the patient, blah, blah, blah. Remember the knife cuts > both ways. For the respondents to this post and others in a similar vein I have > a few questions: Do you collect objective, standardized, risk adjusted outcomes > as well as patient satisfaction data? Justify your " quality of care " with data, > if you can't the rest is just hot air. Time does not equal quality or ethics. > > What about the OP clinics where the PT is there on a Monday doing evaluations > and PTA co-visits for the week not to return till the following Monday to do it > all over again. Who is making the program changes, progressions, modifications > when the PT is not on site for the remainder of the week? On the other hand the > OP clinic with a full time PT/owner, onsite 50 hours/week, with an aide or two. > This PT is in constant contact with knowledge of what each patient's status and > makes program changes daily. > > My heart goes out to the younger PT's that have huge student loans with > expectations of big salaries. My heart also goes out to the facilities whose > individual PT productivity doesn't " cover their nut " , " you want me to see >10 > visits/day and do an eval but what about the ethical one on one care? " Time does > not equal quality or ethics. The tipping point that our profession will be a > loss leader when health care contracts are signed is close at hand. > > Meanwhile, EP and ATC's do " functional testing " for cash with less training > quoting PT research to justify their conclusions. What do we do, " hey they > can't do that " . Yet these groups also get referrals from physicians for post op > " rehab " at your local gym. Why? Simple answer, many of us are too passive with > our interventions. What do we do as PTs? Complain and cry foul but are > unwilling to consider alternative practice settings or adding these skills to > our tool box. > > Quoting Norm from the old TV show CHEERS. " its a dog eat dog world out their and > I'm wearing milk bone shorts " . We are wearing the shorts and giving away more > milk bones. When are we going to turn around and take on the dogs? > > The leaders of our profession have put us into the " one on one treatment " box > which is completely unsustainable. Now its a mantra tied to quality and ethics. > Time does not equal quality or ethics. State boards are there to police the > fraud, overutilization, and improper care issues so let them. > > As a profession we need to raise our productivity, and consider alternative > practice settings to meet the needs of the consumer and market place, or lower > our expectations of pay and benefits. There are other groups out there more > than willing to step in for PT. Profit is not a bad thing but is hard to > justify the hours and stress for 6%. > > > > , I would ask that you withhold my name and email from this post. As a > fellow private practice clinician/owner in the killing fields day in and day out > for the past 20 years I feel that I am jousting with windmills some days. If you > can not withhold I understand, then do not post. We are far too passive as a > profession. > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 Reading this thread I think there is some confusion about what it is legal/ethical to do and what it is legal/ethical to bill. You can have a patient in the clinic doing their exercise program but as Helen Feuron stated many times " Supervised exercise is NOT skilled care " (caps were mine) and if the licensed professional is not doing something skilled (analyzing, modifying, cueing etc) it may be just " supervised exercise " and therefore not billable/reimbursable. An aide supervising for safety does not justify skill just because a licensed professional decided on the program and plan of care. Counting and safety are not skilled activities. There must be therapeutic intervention to justify skill. Knowledge of the patient's status from an unlicensed person and making sure that the activity is being preformed correctly (with the body mechanics and analytical knowledge to make sure the patient is not substituting to perform the correct activity), modified and progressed correctly are two different activities. One is skilled and one is not. That is not to say there is not a place for unskilled (as defined by the codes) and skilled activities, however only the skilled interventions are reimbursable and can be billed by the codes we have. Billing, if you use the codes copyrighted by the AMA which almost all of us do, MUST be by the definitions established by that code. We cannot rationalize that the spirit of the activity is skilled or that having 2 patients at once can justify each getting billed therapeutic exercise at the same time instead of the group code since the Ther ex code clearly states 1 on 1 care (SKILLED one on one care). The one on one treatment box is a billing issue established by the copyrighted codes. This is not a financial decision but the legal use of the billing codes. If you use them, you are agreeing that you are complying with the stated definition not the one you wish it was. We have hurt our profession by having clinics where there is a room full of patients in the gym, who have an established exercise program and handing each a clipboard as they come in where they mark their own reps as they do their own " treatment " with someone (PT ,PTA or aide) supervising. Unfortunately this goes on in many areas and patients tell us daily about this kind of care. Reimbursement is now reflecting this kind of care. But, let us face it, this thread is not about what we can get away with in treatment but what we can bill for. We must read the definitions in each code, remember they are copyrighted and can not be modified by us. If we use them we must use them correctly. And please don't forget we must comply with BOTH the correct copyrighted definition in our billing but our State Laws as well in our treatment. The bottom line, our primary concern should be the patient and treating them with the utmost ethical manner in both our care but in our billing as well.. Off my soap box now..... Sandi Pomeroy, PT Pomeroy Therapeutics Dayton, Ohio _____ From: PTManager [mailto:PTManager ] On Behalf Of Kovacek Sent: Thursday, August 18, 2011 8:04 PM To: PTManager Subject: PT Aides and 97110 Posted on behalf of a PTManager who does not want to be ID'd *************************************************************************** Thanks Rick and others, The focus on one on one care is killing our profession and will be the final nail in the coffin of our profession. Is it a skilled activity to have a PT or PTA stand by grandma and count her reps so you can bill 97110 rather than group? The PT determined the need for the activity, set the parameters of the exercise and fully observes it's set up by a (you fill in the blank). We all hear, and repeat, how great we are but that clinic down the street doesn't spend time with the patient, blah, blah, blah. Remember the knife cuts both ways. For the respondents to this post and others in a similar vein I have a few questions: Do you collect objective, standardized, risk adjusted outcomes as well as patient satisfaction data? Justify your " quality of care " with data, if you can't the rest is just hot air. Time does not equal quality or ethics. What about the OP clinics where the PT is there on a Monday doing evaluations and PTA co-visits for the week not to return till the following Monday to do it all over again. Who is making the program changes, progressions, modifications when the PT is not on site for the remainder of the week? On the other hand the OP clinic with a full time PT/owner, onsite 50 hours/week, with an aide or two. This PT is in constant contact with knowledge of what each patient's status and makes program changes daily. My heart goes out to the younger PT's that have huge student loans with expectations of big salaries. My heart also goes out to the facilities whose individual PT productivity doesn't " cover their nut " , " you want me to see >10 visits/day and do an eval but what about the ethical one on one care? " Time does not equal quality or ethics. The tipping point that our profession will be a loss leader when health care contracts are signed is close at hand. Meanwhile, EP and ATC's do " functional testing " for cash with less training quoting PT research to justify their conclusions. What do we do, " hey they can't do that " . Yet these groups also get referrals from physicians for post op " rehab " at your local gym. Why? Simple answer, many of us are too passive with our interventions. What do we do as PTs? Complain and cry foul but are unwilling to consider alternative practice settings or adding these skills to our tool box. Quoting Norm from the old TV show CHEERS. " its a dog eat dog world out their and I'm wearing milk bone shorts " . We are wearing the shorts and giving away more milk bones. When are we going to turn around and take on the dogs? The leaders of our profession have put us into the " one on one treatment " box which is completely unsustainable. Now its a mantra tied to quality and ethics. Time does not equal quality or ethics. State boards are there to police the fraud, overutilization, and improper care issues so let them. As a profession we need to raise our productivity, and consider alternative practice settings to meet the needs of the consumer and market place, or lower our expectations of pay and benefits. There are other groups out there more than willing to step in for PT. Profit is not a bad thing but is hard to justify the hours and stress for 6%. , I would ask that you withhold my name and email from this post. As a fellow private practice clinician/owner in the killing fields day in and day out for the past 20 years I feel that I am jousting with windmills some days. If you can not withhold I understand, then do not post. We are far too passive as a profession. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 Then if the PT will not always be the, how can the PTA assess the patient and make changes to the POC? They can't. Is the patient at risk? Most likely not if you look at data of malpractice law suits of PT's. Interesting short article on our military. http://www.pacaf.af.mil/news/story.asp?id=123267645 8/11/2011 - KUNSAN AIR BASE, Republic of Korea -- Physical medical technicians with the 8th Medical Group provide necessary physical therapy to patients here, helping return active duty members to full duty status as soon as possible. Staff Sgt. Merced, 8th Medical Operations Squadron, sees patients on a daily basis and assists them with the exercises to improve mobility following an injury. The primary mission of the physical therapy clinic is to assist the hospital commander by providing the necessary physical therapy for patients at Kunsan. This is accomplished by providing acute and sub-acute treatments to the patient population and patient education of both a rehabilitative and preventive nature. The clinic is comprised of one therapist and two technicians, and is one of the smallest physical therapy clinics in the Air Force. " Our clinic here is pretty small compared to other bases, " said Merced. Regardless, they see approximately 15 patients daily among the three of them, with an average of 300 patients per month. Rick Gawenda, PT President Gawenda Seminars & Consulting, Inc. > > Subject: RE: PT Aides and 97110 > To: PTManager > Date: Wednesday, August 17, 2011, 2:34 PM > Aides Use or not use, which is the > question. > > Ever since I first began following PTManager on this list > serve, the > concepts of productivity and use of extenders has been a > strong topic for > discussion. The contributions to the list serve on > this topic usually fall > into one of two categories. However, the crux of the > issue is money; how to > make as much as possible with the staffing and patient mix > in your > particular clinic. > > On the list serve I have observed the semantics and > rationalizations by both > sides of the issue. However, I never have seen anyone > come out and say, " I > use techs and or aides so I can do more than one patient at > a time " . You > know this is the reason. I know this is the reason. > > I have seen arguments stating that the government should > not be telling me > how I should run my practice. One argument being that > " I deserve 100% > autonomy and use my clinical outcomes to make my case for > whether I can see > more than one patient at a time " . The other side > will argue that unless a > PT or PTA delivers the service it is not skilled. > Others state that it is > the level of complexity that determines the criteria or > whether or not it is > skilled. > > I have patients report frequently, that they only see the > therapist one > time, are handed a set of exercises along with a timer, > then shepherded to > the gym where the patient reports being watched by a > aide. The patient > explains that the therapist goes away, many times to wave > at them from > across the room while working with another patient, > sometimes never to > return. Unfortunately the patient does not have > knowledge of one on one > codes, what skilled therapy means, nor any ideas of the 8 > minute rules. The > patient rarely complains about this, they simply do not > return. > > Other times I have patient report wonderful therapists that > took the time to > do the manual work needed to restore function and decrease > pain while > describing their therapists as one that took the time to > explain " the why " > as well as " the what " of diagnosises that they needed > to be understanding. > > The bottom line to my long winded diatribe is that as > therapist we all know > what the definitions of the codes are meant to be. > One on one means one on > one. Skilled means skilled. Group means > group. Supervised means > supervised. You can rationalize as much as you want, > but the meanings do > not change. The only reason to go outside of the > definitions would be > (simply put) to increase profit, make more money, improve > your financial > bottom line. > > I may be a one man band singing this song, but I doubt it. > > Steve Marcum PT > > Outpatient Physical Therapy > > Lexington, KY, 40517 > > > -- > " Anyone who lives a sedentary life and does not exercise, > even if he eats > good foods and takes care of himself according to proper > medical principles, > all his days will be painful ones and his strength shall > wane. " > Maimonides, 1199 AD > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 I love this thread, and will be contributing as much as possible. However, there are many points to consider here, and I feel the need to comment on each point individually. " If I am doing a Maitland mob on a LBP pt, while supervising (line of sight thing) my PT aide helping a pt do a bilateral squat w/o falling, all the while I am barking out orders to make sure they are not taking their knees beyond their toes, what do I do? Not code a 97110, or 97150 if it is a Medicare pt, because the PT aide is standing by the pt for safety purposes? " I have two main thoughts on this point. 1) While you are doing the mobilization, where is your focus? On the patient you are mobilizing? I am sure the patient hopes so, especially since you are doing a technical procedure on their body! Or is your attention on the PT Aide you are barking at. Do you feel the patient working with the aide feels he/she is getting your full attention. 2) At what point do you draw the line on how many PT aides you can bark directions to at any one particular time. 1, 2 why not 6? Is that too many. Barking directions regarding how to do a squat is not particularly challenging. I know that, you know that. Where do you draw the line for what help the PT Aide does. Is your line the standard. What of those that exceed your criteria?? What of those that want to bark out PNF training to a neuro patient. Or NDT techniques, can those be barked out across the gym. Who makes that decision. Presently there is a consensus that determines what is to be billed one on one, what is considered skilled. Is that what needs to be changed? If so then our attention needs to be directed to those writing the CPT codes. PS Please don;t take offense to me using your barking terminology. I was only using it to provide some color to the descriptions. Steve Marcum PT Outpatient Physical Therapy Lexington KY > ** > > > Since I started this very enlightening and productive " conversation " , I > want to chime in and give my 2 cents worth. > > PT aides/techs are being used today for various reasons. They clean, file > paperwork, apply hot/cold packs, get a modality cart, maybe apply the > modality on a patient, stand by a patient for safety reasons during > exercise, be a " voicepiece " for the PT during a pt exercise regimen when the > PT is doing manual therapy on the other side of the gym or because the PT > has to step out to take a phone call; well you get the point. > > There is no standardization for the job of being a PT aide! No common job > description for a PT aide, like there is for PT's and PTA's. > > We know what they can't do and that is provide skilled PT interventions > because they are not schooled and licensed to be a PT. I get that! > > So during a busy day when volume is high on everyones schedule (PT and PTA > alike) so the private practice clinic can make a meager profit (even with > well controlled expenses and cash pay services and decent payor mix) or just > to pay the bills in a reduced reimbursement era, the staff needs help from a > PT aide to keep the place moving smoothly and might have to help with > patient care AT TIMES. Not provide skilled care, but to help the PT or PTA > under their supervision. > > Now under this supervised care, does the PT code for services this PT aide, > " aided " , him or her with under their supervision? > > If I am doing a Maitland mob on a LBP pt, while supervising (line of sight > thing) my PT aide helping a pt do a bilateral squat w/o falling, all the > while I am barking out orders to make sure they are not taking their knees > beyond their toes, what do I do? Not code a 97110, or 97150 if it is a > Medicare pt, because the PT aide is standing by the pt for safety purposes? > I know I would not code it if I left for 15 min to make a phone call and > never watched the pt and PT aide interact. That is not skilled. But if I am > there in the same room as that PT aide and pt while providing care to > another pt, then I have a hard time seeing that as not a skilled service, > and not reimburseable. Especially if I evaluated the pt, know what's good > for them as far what skilled interventions to use, and allow the PT aide, to > aide me, in getting a pt through their visit safely, I would say that is > skilled care. It was my idea to do the squat exercise, my skilled mind, > making that happen, not the PT aides mind. > > I believe we as PTs should use judgement when coding so to honor and uphold > the spirit and integrity of what the code is designed to be used for. To > represent the skilled interventions we do a darn good job at when we take > our profession serious. > > We as PT clinic owners should only hire those people who make our > profession noble, filled with integrity, and respected. We should hire PTs, > PTAs, AND PT Aides/techs that help the clinic provide the best skilled > therapy possible and get paid a reasonable amount for it, with a good > margins, so I can eat some good steak every once in a while, take my > wonderful family to Disney World, and retire before I am 85! > > THOUGHTS??? > > > Hankins, PT > Synergy Therapies, LLC > > To: PTManager > Sent: Thursday, August 18, 2011 1:59 PM > > Subject: RE: PT Aides and 97110 > > > Your assumption is that the PT will be readily available and " see " each > patient prior to treatment. You and I know this will not be the case in all > situations. In that scenario the patient is at risk > Yes it does take the skill of a PT to assess and discern a POC, and yes it > does take skill of a PT to determine response to treatment and adjust , make > changes as needed. > If it were just about doing an US or performing exercise, We( PT) would not > be needed. > > Ron Barbato PT > > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that > is privileged subject to attorney-client privilege or attorney work product, > confidential and/or exempt from disclosure under applicable law. If you are > not the intended recipient, then please do not read it and be aware that any > disclosure, copying, distribution, or use of the information contained > herein (including any reliance thereon) is STRICTLY PROHIBITED. If you > received this transmission in error, please immediately advise me, by reply > e-mail, and delete this message and any attachments without retaining a copy > in any form. Thank you. > > RE: PT Aides and 97110 > > To: PTManager > > Date: Wednesday, August 17, 2011, 2:34 PM > > Aides Use or not use, which is the > > question. > > > > Ever since I first began following PTManager on this list > > serve, the > > concepts of productivity and use of extenders has been a > > strong topic for > > discussion. The contributions to the list serve on > > this topic usually fall > > into one of two categories. However, the crux of the > > issue is money; how to > > make as much as possible with the staffing and patient mix > > in your > > particular clinic. > > > > On the list serve I have observed the semantics and > > rationalizations by both > > sides of the issue. However, I never have seen anyone > > come out and say, " I > > use techs and or aides so I can do more than one patient at > > a time " . You > > know this is the reason. I know this is the reason. > > > > I have seen arguments stating that the government should > > not be telling me > > how I should run my practice. One argument being that > > " I deserve 100% > > autonomy and use my clinical outcomes to make my case for > > whether I can see > > more than one patient at a time " . The other side > > will argue that unless a > > PT or PTA delivers the service it is not skilled. > > Others state that it is > > the level of complexity that determines the criteria or > > whether or not it is > > skilled. > > > > I have patients report frequently, that they only see the > > therapist one > > time, are handed a set of exercises along with a timer, > > then shepherded to > > the gym where the patient reports being watched by a > > aide. The patient > > explains that the therapist goes away, many times to wave > > at them from > > across the room while working with another patient, > > sometimes never to > > return. Unfortunately the patient does not have > > knowledge of one on one > > codes, what skilled therapy means, nor any ideas of the 8 > > minute rules. The > > patient rarely complains about this, they simply do not > > return. > > > > Other times I have patient report wonderful therapists that > > took the time to > > do the manual work needed to restore function and decrease > > pain while > > describing their therapists as one that took the time to > > explain " the why " > > as well as " the what " of diagnosises that they needed > > to be understanding. > > > > The bottom line to my long winded diatribe is that as > > therapist we all know > > what the definitions of the codes are meant to be. > > One on one means one on > > one. Skilled means skilled. Group means > > group. Supervised means > > supervised. You can rationalize as much as you want, > > but the meanings do > > not change. The only reason to go outside of the > > definitions would be > > (simply put) to increase profit, make more money, improve > > your financial > > bottom line. > > > > I may be a one man band singing this song, but I doubt it. > > > > Steve Marcum PT > > > > Outpatient Physical Therapy > > > > Lexington, KY, 40517 > > > > > > -- > > " Anyone who lives a sedentary life and does not exercise, > > even if he eats > > good foods and takes care of himself according to proper > > medical principles, > > all his days will be painful ones and his strength shall > > wane. " > > Maimonides, 1199 AD > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 I love this thread, and will be contributing as much as possible. However, there are many points to consider here, and I feel the need to comment on each point individually. " If I am doing a Maitland mob on a LBP pt, while supervising (line of sight thing) my PT aide helping a pt do a bilateral squat w/o falling, all the while I am barking out orders to make sure they are not taking their knees beyond their toes, what do I do? Not code a 97110, or 97150 if it is a Medicare pt, because the PT aide is standing by the pt for safety purposes? " I have two main thoughts on this point. 1) While you are doing the mobilization, where is your focus? On the patient you are mobilizing? I am sure the patient hopes so, especially since you are doing a technical procedure on their body! Or is your attention on the PT Aide you are barking at. Do you feel the patient working with the aide feels he/she is getting your full attention. 2) At what point do you draw the line on how many PT aides you can bark directions to at any one particular time. 1, 2 why not 6? Is that too many. Barking directions regarding how to do a squat is not particularly challenging. I know that, you know that. Where do you draw the line for what help the PT Aide does. Is your line the standard. What of those that exceed your criteria?? What of those that want to bark out PNF training to a neuro patient. Or NDT techniques, can those be barked out across the gym. Who makes that decision. Presently there is a consensus that determines what is to be billed one on one, what is considered skilled. Is that what needs to be changed? If so then our attention needs to be directed to those writing the CPT codes. PS Please don;t take offense to me using your barking terminology. I was only using it to provide some color to the descriptions. Steve Marcum PT Outpatient Physical Therapy Lexington KY > ** > > > Since I started this very enlightening and productive " conversation " , I > want to chime in and give my 2 cents worth. > > PT aides/techs are being used today for various reasons. They clean, file > paperwork, apply hot/cold packs, get a modality cart, maybe apply the > modality on a patient, stand by a patient for safety reasons during > exercise, be a " voicepiece " for the PT during a pt exercise regimen when the > PT is doing manual therapy on the other side of the gym or because the PT > has to step out to take a phone call; well you get the point. > > There is no standardization for the job of being a PT aide! No common job > description for a PT aide, like there is for PT's and PTA's. > > We know what they can't do and that is provide skilled PT interventions > because they are not schooled and licensed to be a PT. I get that! > > So during a busy day when volume is high on everyones schedule (PT and PTA > alike) so the private practice clinic can make a meager profit (even with > well controlled expenses and cash pay services and decent payor mix) or just > to pay the bills in a reduced reimbursement era, the staff needs help from a > PT aide to keep the place moving smoothly and might have to help with > patient care AT TIMES. Not provide skilled care, but to help the PT or PTA > under their supervision. > > Now under this supervised care, does the PT code for services this PT aide, > " aided " , him or her with under their supervision? > > If I am doing a Maitland mob on a LBP pt, while supervising (line of sight > thing) my PT aide helping a pt do a bilateral squat w/o falling, all the > while I am barking out orders to make sure they are not taking their knees > beyond their toes, what do I do? Not code a 97110, or 97150 if it is a > Medicare pt, because the PT aide is standing by the pt for safety purposes? > I know I would not code it if I left for 15 min to make a phone call and > never watched the pt and PT aide interact. That is not skilled. But if I am > there in the same room as that PT aide and pt while providing care to > another pt, then I have a hard time seeing that as not a skilled service, > and not reimburseable. Especially if I evaluated the pt, know what's good > for them as far what skilled interventions to use, and allow the PT aide, to > aide me, in getting a pt through their visit safely, I would say that is > skilled care. It was my idea to do the squat exercise, my skilled mind, > making that happen, not the PT aides mind. > > I believe we as PTs should use judgement when coding so to honor and uphold > the spirit and integrity of what the code is designed to be used for. To > represent the skilled interventions we do a darn good job at when we take > our profession serious. > > We as PT clinic owners should only hire those people who make our > profession noble, filled with integrity, and respected. We should hire PTs, > PTAs, AND PT Aides/techs that help the clinic provide the best skilled > therapy possible and get paid a reasonable amount for it, with a good > margins, so I can eat some good steak every once in a while, take my > wonderful family to Disney World, and retire before I am 85! > > THOUGHTS??? > > > Hankins, PT > Synergy Therapies, LLC > > To: PTManager > Sent: Thursday, August 18, 2011 1:59 PM > > Subject: RE: PT Aides and 97110 > > > Your assumption is that the PT will be readily available and " see " each > patient prior to treatment. You and I know this will not be the case in all > situations. In that scenario the patient is at risk > Yes it does take the skill of a PT to assess and discern a POC, and yes it > does take skill of a PT to determine response to treatment and adjust , make > changes as needed. > If it were just about doing an US or performing exercise, We( PT) would not > be needed. > > Ron Barbato PT > > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that > is privileged subject to attorney-client privilege or attorney work product, > confidential and/or exempt from disclosure under applicable law. If you are > not the intended recipient, then please do not read it and be aware that any > disclosure, copying, distribution, or use of the information contained > herein (including any reliance thereon) is STRICTLY PROHIBITED. If you > received this transmission in error, please immediately advise me, by reply > e-mail, and delete this message and any attachments without retaining a copy > in any form. Thank you. > > RE: PT Aides and 97110 > > To: PTManager > > Date: Wednesday, August 17, 2011, 2:34 PM > > Aides Use or not use, which is the > > question. > > > > Ever since I first began following PTManager on this list > > serve, the > > concepts of productivity and use of extenders has been a > > strong topic for > > discussion. The contributions to the list serve on > > this topic usually fall > > into one of two categories. However, the crux of the > > issue is money; how to > > make as much as possible with the staffing and patient mix > > in your > > particular clinic. > > > > On the list serve I have observed the semantics and > > rationalizations by both > > sides of the issue. However, I never have seen anyone > > come out and say, " I > > use techs and or aides so I can do more than one patient at > > a time " . You > > know this is the reason. I know this is the reason. > > > > I have seen arguments stating that the government should > > not be telling me > > how I should run my practice. One argument being that > > " I deserve 100% > > autonomy and use my clinical outcomes to make my case for > > whether I can see > > more than one patient at a time " . The other side > > will argue that unless a > > PT or PTA delivers the service it is not skilled. > > Others state that it is > > the level of complexity that determines the criteria or > > whether or not it is > > skilled. > > > > I have patients report frequently, that they only see the > > therapist one > > time, are handed a set of exercises along with a timer, > > then shepherded to > > the gym where the patient reports being watched by a > > aide. The patient > > explains that the therapist goes away, many times to wave > > at them from > > across the room while working with another patient, > > sometimes never to > > return. Unfortunately the patient does not have > > knowledge of one on one > > codes, what skilled therapy means, nor any ideas of the 8 > > minute rules. The > > patient rarely complains about this, they simply do not > > return. > > > > Other times I have patient report wonderful therapists that > > took the time to > > do the manual work needed to restore function and decrease > > pain while > > describing their therapists as one that took the time to > > explain " the why " > > as well as " the what " of diagnosises that they needed > > to be understanding. > > > > The bottom line to my long winded diatribe is that as > > therapist we all know > > what the definitions of the codes are meant to be. > > One on one means one on > > one. Skilled means skilled. Group means > > group. Supervised means > > supervised. You can rationalize as much as you want, > > but the meanings do > > not change. The only reason to go outside of the > > definitions would be > > (simply put) to increase profit, make more money, improve > > your financial > > bottom line. > > > > I may be a one man band singing this song, but I doubt it. > > > > Steve Marcum PT > > > > Outpatient Physical Therapy > > > > Lexington, KY, 40517 > > > > > > -- > > " Anyone who lives a sedentary life and does not exercise, > > even if he eats > > good foods and takes care of himself according to proper > > medical principles, > > all his days will be painful ones and his strength shall > > wane. " > > Maimonides, 1199 AD > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 LIstserv, Good discussion here folks, but it's getting a little more heated and venomous than it needs to be. There are published studies on the subject, and no one seems to be referencing the state of the peer-reviewed knowledge on the subject. Personally, I'd submit that sometimes it matters who provides care and for how long, and sometimes it does not . . . the trick is to be able to determine upon initial evaluation which type of patient is which. In that vein, I would point ya'll to a recent case report published in the International Journal of Physiotherapy and Rehabilitation (Open Access at ijptr.com --- meaning free full text for all to see) in which a patient initially treated in a Physician Owned Practice, (sometimes by techs and unlicensed paraprofessionals), and ALWAYS in tandem with other patients, realized ZERO improvement in any impairment level or functional outcome measure until referred to a hospital outpatient facility in which 1:1 care was received. Several possible variables explaining this were hypothesized, one of which being that although some patients may be treated effectively in a treatment mill, that there is very clearly a subset of patients that may require additional (sometimes non-billable time). What is needed is better clinical assessments and prediction rules to sort out one type of patient from the other, and ultimately the education physicians, insurance companies, and physical therapists as to which treatment environments services should be provided and reimbursed, and which treatment environments we should all agree that they should not. On the basis of the outcome in the case report, the author calls for additional research in a variety of areas, but hypothosises an interesting point, " If non-clinical factors are found to be of value in outcome prediction in patients who are not found to be ideal candidates for HVLAT on the basis of existing CPR’s, it is worth considering that some of these factors may require additional (sometimes non-billable) time to establish. Simply taking a few minutes of extra time to listen to a patient’s complaints that may not be directly applicable to the physical therapy case may have the effect of easing a patient’s anxieties and allow for improved outcomes as a direct effect of relaxation, or by relaxing the patient sufficiently to optimally benefit from manual modalities. As such, the treatment environment and/or direct 1:1 time spent with the patient may be an important factor in predicting outcome in patients such as the one described in this case report. Physical therapists in non-physician-owned environments have been found to spend as much as 60% more time per visit with their patients ( and , 1992). The patient in this case was treated initially in a physician’s owned practice where she did not improve, and subsequently in a non-physician owned practice (where greater direct 1:1 time was spent with the patient), where she did improve. In other words, additional research is needed to determine if it is time spent building rapport with the patient who scores poorly on the CPR’s, or the treatment environment itself, that ultimately proves more predictive. Additional research will be required to fully explore the impact of non-clinical factors in predicting outcomes in patients who score in the less-than-ideal range on established clinical prediction rules. Early identification of these patients, and the factors (both clinical and non-clinical) that predict their outcomes from the receipt of specific physical therapy techniques and treatment environments may lead to improved efficiency and cost-effectiveness in the treatment of this subgroup of patients with neck-pain. " All this is to answer the question, " Do you collect objective, standardized, risk adjusted outcomes as well as patient satisfaction data? Justify your " quality of care " with data, if you can't the rest is just hot air. Time does not equal quality or ethics. " The answer is that YES, to your probable dismay, YES we collect that data, YES there is an emerging body of published literature examining outcomes, and it seems to suggest that while time is not established as equal to quality or ethics for so patients, there is a direct relationship within specific, detectable, subsets of patients. Sticking one's head in the sand and ignoring that fact is every bit as inappropriate as insisting that there are NO patients whatsoever who may do just fine in physical therapy regardless of who provides the care, and to what intensity of direct care. The characterization of opponents to your position as blowing " hot air " and then hiding behind an " Anonymous " tag (in violation of listserv rules, one might add), frankly may reveal more of your (un)professional character and ethics than your position on the discussion itself --- and while a well written and subsitinative post, should be viewed by all other listserv members through that lens of apparent cowardice and self-doubt. , on the other hand, writes another compelling post. While I don't agree with the position you've taken here, I certainly sympathize on the plight and welcome discussion on the topic of " what can we do? " I'd submit that we as a profession are AWFUL at learning from other non-physician doctoring professions that have come before us. Pharmacists, for example, realized long ago that they could not sustain on their clinical services alone. Optometrists, similarly, often own optical shops. For the amount of time I spend with my patients with low-back or lower-quarter symptoms, and the time I spend educating them, in the running store, about proper footwear .. . . I am increasingly confused as to why virtually no shoe stores are owned by orthopedic physical therapists . . . is the margin too small? M. Ball, PT, DPT, PhD Orthopedic Physical Therapy Resident Carolinas Rehabilitation, Charlotte, NC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 LIstserv, Good discussion here folks, but it's getting a little more heated and venomous than it needs to be. There are published studies on the subject, and no one seems to be referencing the state of the peer-reviewed knowledge on the subject. Personally, I'd submit that sometimes it matters who provides care and for how long, and sometimes it does not . . . the trick is to be able to determine upon initial evaluation which type of patient is which. In that vein, I would point ya'll to a recent case report published in the International Journal of Physiotherapy and Rehabilitation (Open Access at ijptr.com --- meaning free full text for all to see) in which a patient initially treated in a Physician Owned Practice, (sometimes by techs and unlicensed paraprofessionals), and ALWAYS in tandem with other patients, realized ZERO improvement in any impairment level or functional outcome measure until referred to a hospital outpatient facility in which 1:1 care was received. Several possible variables explaining this were hypothesized, one of which being that although some patients may be treated effectively in a treatment mill, that there is very clearly a subset of patients that may require additional (sometimes non-billable time). What is needed is better clinical assessments and prediction rules to sort out one type of patient from the other, and ultimately the education physicians, insurance companies, and physical therapists as to which treatment environments services should be provided and reimbursed, and which treatment environments we should all agree that they should not. On the basis of the outcome in the case report, the author calls for additional research in a variety of areas, but hypothosises an interesting point, " If non-clinical factors are found to be of value in outcome prediction in patients who are not found to be ideal candidates for HVLAT on the basis of existing CPR’s, it is worth considering that some of these factors may require additional (sometimes non-billable) time to establish. Simply taking a few minutes of extra time to listen to a patient’s complaints that may not be directly applicable to the physical therapy case may have the effect of easing a patient’s anxieties and allow for improved outcomes as a direct effect of relaxation, or by relaxing the patient sufficiently to optimally benefit from manual modalities. As such, the treatment environment and/or direct 1:1 time spent with the patient may be an important factor in predicting outcome in patients such as the one described in this case report. Physical therapists in non-physician-owned environments have been found to spend as much as 60% more time per visit with their patients ( and , 1992). The patient in this case was treated initially in a physician’s owned practice where she did not improve, and subsequently in a non-physician owned practice (where greater direct 1:1 time was spent with the patient), where she did improve. In other words, additional research is needed to determine if it is time spent building rapport with the patient who scores poorly on the CPR’s, or the treatment environment itself, that ultimately proves more predictive. Additional research will be required to fully explore the impact of non-clinical factors in predicting outcomes in patients who score in the less-than-ideal range on established clinical prediction rules. Early identification of these patients, and the factors (both clinical and non-clinical) that predict their outcomes from the receipt of specific physical therapy techniques and treatment environments may lead to improved efficiency and cost-effectiveness in the treatment of this subgroup of patients with neck-pain. " All this is to answer the question, " Do you collect objective, standardized, risk adjusted outcomes as well as patient satisfaction data? Justify your " quality of care " with data, if you can't the rest is just hot air. Time does not equal quality or ethics. " The answer is that YES, to your probable dismay, YES we collect that data, YES there is an emerging body of published literature examining outcomes, and it seems to suggest that while time is not established as equal to quality or ethics for so patients, there is a direct relationship within specific, detectable, subsets of patients. Sticking one's head in the sand and ignoring that fact is every bit as inappropriate as insisting that there are NO patients whatsoever who may do just fine in physical therapy regardless of who provides the care, and to what intensity of direct care. The characterization of opponents to your position as blowing " hot air " and then hiding behind an " Anonymous " tag (in violation of listserv rules, one might add), frankly may reveal more of your (un)professional character and ethics than your position on the discussion itself --- and while a well written and subsitinative post, should be viewed by all other listserv members through that lens of apparent cowardice and self-doubt. , on the other hand, writes another compelling post. While I don't agree with the position you've taken here, I certainly sympathize on the plight and welcome discussion on the topic of " what can we do? " I'd submit that we as a profession are AWFUL at learning from other non-physician doctoring professions that have come before us. Pharmacists, for example, realized long ago that they could not sustain on their clinical services alone. Optometrists, similarly, often own optical shops. For the amount of time I spend with my patients with low-back or lower-quarter symptoms, and the time I spend educating them, in the running store, about proper footwear .. . . I am increasingly confused as to why virtually no shoe stores are owned by orthopedic physical therapists . . . is the margin too small? M. Ball, PT, DPT, PhD Orthopedic Physical Therapy Resident Carolinas Rehabilitation, Charlotte, NC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 Rick, Since the military is both the provider and the payer, they are not under the same constants that civilian providers are under. The least constrained method of PT service delivery in the military would seem to be the most efficient and cost effective. Even if the military model shows well documented proof that quality care can be provided by utilizing multiple tech to PT ratios in the delivery of PT services, there is still the issue of the 1. AMAs CPT definitions, 2. state practice act rules and 3. contractual agreement restrictions that restrict PT service delivery in the civilian world. Until these three constraining issues are removed, any comparison between military and civilian PT services results only in lively conversation. We should realistically question: What incentive or disincentive is there for these constraints to be removed by the AMA, State Board, or third party payers? Jon Mark Pleasant, PT > > > > > > > > Subject: RE: PT Aides and 97110 > > > To: PTManager > > > Date: Wednesday, August 17, 2011, 2:34 PM > > > Aides Use or not use, which is the > > > question. > > > > > > Ever since I first began following PTManager on this list > > > serve, the > > > concepts of productivity and use of extenders has been a > > > strong topic for > > > discussion. The contributions to the list serve on > > > this topic usually fall > > > into one of two categories. However, the crux of the > > > issue is money; how to > > > make as much as possible with the staffing and patient mix > > > in your > > > particular clinic. > > > > > > On the list serve I have observed the semantics and > > > rationalizations by both > > > sides of the issue. However, I never have seen anyone > > > come out and say, " I > > > use techs and or aides so I can do more than one patient at > > > a time " . You > > > know this is the reason. I know this is the reason. > > > > > > I have seen arguments stating that the government should > > > not be telling me > > > how I should run my practice. One argument being that > > > " I deserve 100% > > > autonomy and use my clinical outcomes to make my case for > > > whether I can see > > > more than one patient at a time " . The other side > > > will argue that unless a > > > PT or PTA delivers the service it is not skilled. > > > Others state that it is > > > the level of complexity that determines the criteria or > > > whether or not it is > > > skilled. > > > > > > I have patients report frequently, that they only see the > > > therapist one > > > time, are handed a set of exercises along with a timer, > > > then shepherded to > > > the gym where the patient reports being watched by a > > > aide. The patient > > > explains that the therapist goes away, many times to wave > > > at them from > > > across the room while working with another patient, > > > sometimes never to > > > return. Unfortunately the patient does not have > > > knowledge of one on one > > > codes, what skilled therapy means, nor any ideas of the 8 > > > minute rules. The > > > patient rarely complains about this, they simply do not > > > return. > > > > > > Other times I have patient report wonderful therapists that > > > took the time to > > > do the manual work needed to restore function and decrease > > > pain while > > > describing their therapists as one that took the time to > > > explain " the why " > > > as well as " the what " of diagnosises that they needed > > > to be understanding. > > > > > > The bottom line to my long winded diatribe is that as > > > therapist we all know > > > what the definitions of the codes are meant to be. > > > One on one means one on > > > one. Skilled means skilled. Group means > > > group. Supervised means > > > supervised. You can rationalize as much as you want, > > > but the meanings do > > > not change. The only reason to go outside of the > > > definitions would be > > > (simply put) to increase profit, make more money, improve > > > your financial > > > bottom line. > > > > > > I may be a one man band singing this song, but I doubt it. > > > > > > Steve Marcum PT > > > > > > Outpatient Physical Therapy > > > > > > Lexington, KY, 40517 > > > > > > > > > -- > > > " Anyone who lives a sedentary life and does not exercise, > > > even if he eats > > > good foods and takes care of himself according to proper > > > medical principles, > > > all his days will be painful ones and his strength shall > > > wane. " > > > Maimonides, 1199 AD > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 Steve and Group,  Aren't we having fun now?! I love this thread as well, and am becoming deeply enlightened on all the " other " issues that are coming into light now that we are talking openly, honestly and with great passion about PT aides, quality, code definitions, etc.  No offense taken with barking. I love to bark, but in a caring and diplomatic way. Ha!  Anyhoo, let's take this point by point,  #1 - Focus son! ala Karate Kid. Where I focus my attention and " skill " is what makes a seasoned PT worth his/her weight in " reimbursement " code. ly I believe it should be more that what I'm getting now, but that's the contract I signed. I digress.  Who is to judge the quality of the skill I'm providing to my LBP and my squatting pt? ME ya'll, not the AMA! And Steve, you also determine the quality of your skill when treating two people at the same time, with or without a PT aide. To 97150 or not to 97150, that is the question.  The whole one on one treatment coding thing was created by the AMA code writers, or " judges " of our value, thus judging us as worth $30 for a 97110 code or $18 for a 97150 group code per my carrier number in MO. So seeing more than one pt at a time is worth less. Why did they do this? Obviously it was done to curtail fraudulant billing practices in the 80's and 90's, but is treating more than one person at a time worth less than one on one? Depends on many variables.  Barking out orders, sorry had to do it, to two pts, one squatting and one doing a plank, is that worth $18 of a 97150 or $30 of 97110? Only the treating/evaluating PT knows, not the AMA. So it is up to the PT to code it appropriately. Of course, now you have to trust the PT, and it is obvious the insurance companies don't trust us during that decisive moment. So we have to code it 97150 for Medicare pts or one 97110 for one and none for the other based on how long you treated those two pts at the same time. Friggin' love the coding rules. NOT!  #2 - How many PT aides is enough? 1 PT aide/2 PTs. Just makes sense to me. Some would agree, some would disagree, based on my reasoning.  We need to lobby against the AMA and get the rules changed in a reasonable and peaceful way so to maintain proper incentivization (is that a word?) to do one on one care (the ideal way) or just go rogue and do cash pay, and let the local republic/community we serve determine it's value based on supply and demand.  Thoughts???  Peace, Hankins, PT Synergy Therapies, LLC  To: PTManager Sent: Thursday, August 18, 2011 9:06 PM Subject: Re: PT Aides and 97110 I love this thread, and will be contributing as much as possible. However, there are many points to consider here, and I feel the need to comment on each point individually. " If I am doing a Maitland mob on a LBP pt, while supervising (line of sight thing) my PT aide helping a pt do a bilateral squat w/o falling, all the while I am barking out orders to make sure they are not taking their knees beyond their toes, what do I do? Not code a 97110, or 97150 if it is a Medicare pt, because the PT aide is standing by the pt for safety purposes? " I have two main thoughts on this point. 1) While you are doing the mobilization, where is your focus? On the patient you are mobilizing? I am sure the patient hopes so, especially since you are doing a technical procedure on their body! Or is your attention on the PT Aide you are barking at. Do you feel the patient working with the aide feels he/she is getting your full attention. 2) At what point do you draw the line on how many PT aides you can bark directions to at any one particular time. 1, 2 why not 6? Is that too many. Barking directions regarding how to do a squat is not particularly challenging. I know that, you know that. Where do you draw the line for what help the PT Aide does. Is your line the standard. What of those that exceed your criteria??  What of those that want to bark out PNF training to a neuro patient. Or NDT techniques, can those be barked out across the gym. Who makes that decision. Presently there is a consensus that determines what is to be billed one on one, what is considered skilled. Is that what needs to be changed? If so then our attention needs to be directed to those writing the CPT codes. PS Please don;t take offense to me using your barking terminology. I was only using it to provide some color to the descriptions. Steve Marcum PT Outpatient Physical Therapy Lexington KY > ** > > > Since I started this very enlightening and productive " conversation " , I > want to chime in and give my 2 cents worth. > > PT aides/techs are being used today for various reasons. They clean, file > paperwork, apply hot/cold packs, get a modality cart, maybe apply the > modality on a patient, stand by a patient for safety reasons during > exercise, be a " voicepiece " for the PT during a pt exercise regimen when the > PT is doing manual therapy on the other side of the gym or because the PT > has to step out to take a phone call; well you get the point. > > There is no standardization for the job of being a PT aide! No common job > description for a PT aide, like there is for PT's and PTA's. > > We know what they can't do and that is provide skilled PT interventions > because they are not schooled and licensed to be a PT. I get that! > > So during a busy day when volume is high on everyones schedule (PT and PTA > alike) so the private practice clinic can make a meager profit (even with > well controlled expenses and cash pay services and decent payor mix) or just > to pay the bills in a reduced reimbursement era, the staff needs help from a > PT aide to keep the place moving smoothly and might have to help with > patient care AT TIMES. Not provide skilled care, but to help the PT or PTA > under their supervision. > > Now under this supervised care, does the PT code for services this PT aide, > " aided " , him or her with under their supervision? > > If I am doing a Maitland mob on a LBP pt, while supervising (line of sight > thing) my PT aide helping a pt do a bilateral squat w/o falling, all the > while I am barking out orders to make sure they are not taking their knees > beyond their toes, what do I do? Not code a 97110, or 97150 if it is a > Medicare pt, because the PT aide is standing by the pt for safety purposes? > I know I would not code it if I left for 15 min to make a phone call and > never watched the pt and PT aide interact. That is not skilled. But if I am > there in the same room as that PT aide and pt while providing care to > another pt, then I have a hard time seeing that as not a skilled service, > and not reimburseable. Especially if I evaluated the pt, know what's good > for them as far what skilled interventions to use, and allow the PT aide, to > aide me, in getting a pt through their visit safely, I would say that is > skilled care. It was my idea to do the squat exercise, my skilled mind, > making that happen, not the PT aides mind. > > I believe we as PTs should use judgement when coding so to honor and uphold > the spirit and integrity of what the code is designed to be used for. To > represent the skilled interventions we do a darn good job at when we take > our profession serious. > > We as PT clinic owners should only hire those people who make our > profession noble, filled with integrity, and respected. We should hire PTs, > PTAs, AND PT Aides/techs that help the clinic provide the best skilled > therapy possible and get paid a reasonable amount for it, with a good > margins, so I can eat some good steak every once in a while, take my > wonderful family to Disney World, and retire before I am 85! > > THOUGHTS??? > > > Hankins, PT > Synergy Therapies, LLC > > To: PTManager > Sent: Thursday, August 18, 2011 1:59 PM > > Subject: RE: PT Aides and 97110 > > > Your assumption is that the PT will be readily available and " see " each > patient prior to treatment. You and I know this will not be the case in all > situations. In that scenario the patient is at risk > Yes it does take the skill of a PT to assess and discern a POC, and yes it > does take skill of a PT to determine response to treatment and adjust , make > changes as needed. > If it were just about doing an US or performing exercise, We( PT) would not > be needed. > > Ron Barbato PT > > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that > is privileged subject to attorney-client privilege or attorney work product, > confidential and/or exempt from disclosure under applicable law. If you are > not the intended recipient, then please do not read it and be aware that any > disclosure, copying, distribution, or use of the information contained > herein (including any reliance thereon) is STRICTLY PROHIBITED. If you > received this transmission in error, please immediately advise me, by reply > e-mail, and delete this message and any attachments without retaining a copy > in any form. Thank you. > > RE: PT Aides and 97110 > > To: PTManager > > Date: Wednesday, August 17, 2011, 2:34 PM > > Aides Use or not use, which is the > > question. > > > > Ever since I first began following PTManager on this list > > serve, the > > concepts of productivity and use of extenders has been a > > strong topic for > > discussion. The contributions to the list serve on > > this topic usually fall > > into one of two categories. However, the crux of the > > issue is money; how to > > make as much as possible with the staffing and patient mix > > in your > > particular clinic. > > > > On the list serve I have observed the semantics and > > rationalizations by both > > sides of the issue. However, I never have seen anyone > > come out and say, " I > > use techs and or aides so I can do more than one patient at > > a time " . You > > know this is the reason. I know this is the reason. > > > > I have seen arguments stating that the government should > > not be telling me > > how I should run my practice. One argument being that > > " I deserve 100% > > autonomy and use my clinical outcomes to make my case for > > whether I can see > > more than one patient at a time " . The other side > > will argue that unless a > > PT or PTA delivers the service it is not skilled. > > Others state that it is > > the level of complexity that determines the criteria or > > whether or not it is > > skilled. > > > > I have patients report frequently, that they only see the > > therapist one > > time, are handed a set of exercises along with a timer, > > then shepherded to > > the gym where the patient reports being watched by a > > aide. The patient > > explains that the therapist goes away, many times to wave > > at them from > > across the room while working with another patient, > > sometimes never to > > return. Unfortunately the patient does not have > > knowledge of one on one > > codes, what skilled therapy means, nor any ideas of the 8 > > minute rules. The > > patient rarely complains about this, they simply do not > > return. > > > > Other times I have patient report wonderful therapists that > > took the time to > > do the manual work needed to restore function and decrease > > pain while > > describing their therapists as one that took the time to > > explain " the why " > > as well as " the what " of diagnosises that they needed > > to be understanding. > > > > The bottom line to my long winded diatribe is that as > > therapist we all know > > what the definitions of the codes are meant to be. > > One on one means one on > > one. Skilled means skilled. Group means > > group. Supervised means > > supervised. You can rationalize as much as you want, > > but the meanings do > > not change. The only reason to go outside of the > > definitions would be > > (simply put) to increase profit, make more money, improve > > your financial > > bottom line. > > > > I may be a one man band singing this song, but I doubt it. > > > > Steve Marcum PT > > > > Outpatient Physical Therapy > > > > Lexington, KY, 40517 > > > > > > -- > > " Anyone who lives a sedentary life and does not exercise, > > even if he eats > > good foods and takes care of himself according to proper > > medical principles, > > all his days will be painful ones and his strength shall > > wane. " > > Maimonides, 1199 AD > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 18, 2011 Report Share Posted August 18, 2011 , 97110 is a 1:1 code, not a group code. If you treated both patients concurrently for 16 minutes total, doing what amounts to 8 minutes of supervised and skilled " barking " at one while doing 8 minutes of manual therapy on the other - - - then sure, go ahead and bill each patient one unit, or a group code for each patient for the entire 16 minutes. The billing system that we have is, in my opinion, nonsense. Why don't we simply, like physicians, have two evaluation codes (basic and extended), and two treatment codes (basic and extended)? Clean. Not time dependent. Not tied to 1:1. Respecting our status as CLINICAL DOCTORS, simple, codes? M. Ball, PT, DPT, PhD Orthopedic Physical Therapy Resident Carolinas Rehabilitation Charlotte, NC > ** > > > Since I started this very enlightening and productive " conversation " , I > want to chime in and give my 2 cents worth. > > PT aides/techs are being used today for various reasons. They clean, file > paperwork, apply hot/cold packs, get a modality cart, maybe apply the > modality on a patient, stand by a patient for safety reasons during > exercise, be a " voicepiece " for the PT during a pt exercise regimen when the > PT is doing manual therapy on the other side of the gym or because the PT > has to step out to take a phone call; well you get the point. > > There is no standardization for the job of being a PT aide! No common job > description for a PT aide, like there is for PT's and PTA's. > > We know what they can't do and that is provide skilled PT interventions > because they are not schooled and licensed to be a PT. I get that! > > So during a busy day when volume is high on everyones schedule (PT and PTA > alike) so the private practice clinic can make a meager profit (even with > well controlled expenses and cash pay services and decent payor mix) or just > to pay the bills in a reduced reimbursement era, the staff needs help from a > PT aide to keep the place moving smoothly and might have to help with > patient care AT TIMES. Not provide skilled care, but to help the PT or PTA > under their supervision. > > Now under this supervised care, does the PT code for services this PT aide, > " aided " , him or her with under their supervision? > > If I am doing a Maitland mob on a LBP pt, while supervising (line of sight > thing) my PT aide helping a pt do a bilateral squat w/o falling, all the > while I am barking out orders to make sure they are not taking their knees > beyond their toes, what do I do? Not code a 97110, or 97150 if it is a > Medicare pt, because the PT aide is standing by the pt for safety purposes? > I know I would not code it if I left for 15 min to make a phone call and > never watched the pt and PT aide interact. That is not skilled. But if I am > there in the same room as that PT aide and pt while providing care to > another pt, then I have a hard time seeing that as not a skilled service, > and not reimburseable. Especially if I evaluated the pt, know what's good > for them as far what skilled interventions to use, and allow the PT aide, to > aide me, in getting a pt through their visit safely, I would say that is > skilled care. It was my idea to do the squat exercise, my skilled mind, > making that happen, not the PT aides mind. > > I believe we as PTs should use judgement when coding so to honor and uphold > the spirit and integrity of what the code is designed to be used for. To > represent the skilled interventions we do a darn good job at when we take > our profession serious. > > We as PT clinic owners should only hire those people who make our > profession noble, filled with integrity, and respected. We should hire PTs, > PTAs, AND PT Aides/techs that help the clinic provide the best skilled > therapy possible and get paid a reasonable amount for it, with a good > margins, so I can eat some good steak every once in a while, take my > wonderful family to Disney World, and retire before I am 85! > > THOUGHTS??? > > Hankins, PT > Synergy Therapies, LLC > > To: PTManager > Sent: Thursday, August 18, 2011 1:59 PM > > Subject: RE: PT Aides and 97110 > > > Your assumption is that the PT will be readily available and " see " each > patient prior to treatment. You and I know this will not be the case in all > situations. In that scenario the patient is at risk > Yes it does take the skill of a PT to assess and discern a POC, and yes it > does take skill of a PT to determine response to treatment and adjust , make > changes as needed. > If it were just about doing an US or performing exercise, We( PT) would not > be needed. > > Ron Barbato PT > > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that > is privileged subject to attorney-client privilege or attorney work product, > confidential and/or exempt from disclosure under applicable law. If you are > not the intended recipient, then please do not read it and be aware that any > disclosure, copying, distribution, or use of the information contained > herein (including any reliance thereon) is STRICTLY PROHIBITED. If you > received this transmission in error, please immediately advise me, by reply > e-mail, and delete this message and any attachments without retaining a copy > in any form. Thank you. > > RE: PT Aides and 97110 > > To: PTManager > > Date: Wednesday, August 17, 2011, 2:34 PM > > Aides Use or not use, which is the > > question. > > > > Ever since I first began following PTManager on this list > > serve, the > > concepts of productivity and use of extenders has been a > > strong topic for > > discussion. The contributions to the list serve on > > this topic usually fall > > into one of two categories. However, the crux of the > > issue is money; how to > > make as much as possible with the staffing and patient mix > > in your > > particular clinic. > > > > On the list serve I have observed the semantics and > > rationalizations by both > > sides of the issue. However, I never have seen anyone > > come out and say, " I > > use techs and or aides so I can do more than one patient at > > a time " . You > > know this is the reason. I know this is the reason. > > > > I have seen arguments stating that the government should > > not be telling me > > how I should run my practice. One argument being that > > " I deserve 100% > > autonomy and use my clinical outcomes to make my case for > > whether I can see > > more than one patient at a time " . The other side > > will argue that unless a > > PT or PTA delivers the service it is not skilled. > > Others state that it is > > the level of complexity that determines the criteria or > > whether or not it is > > skilled. > > > > I have patients report frequently, that they only see the > > therapist one > > time, are handed a set of exercises along with a timer, > > then shepherded to > > the gym where the patient reports being watched by a > > aide. The patient > > explains that the therapist goes away, many times to wave > > at them from > > across the room while working with another patient, > > sometimes never to > > return. Unfortunately the patient does not have > > knowledge of one on one > > codes, what skilled therapy means, nor any ideas of the 8 > > minute rules. The > > patient rarely complains about this, they simply do not > > return. > > > > Other times I have patient report wonderful therapists that > > took the time to > > do the manual work needed to restore function and decrease > > pain while > > describing their therapists as one that took the time to > > explain " the why " > > as well as " the what " of diagnosises that they needed > > to be understanding. > > > > The bottom line to my long winded diatribe is that as > > therapist we all know > > what the definitions of the codes are meant to be. > > One on one means one on > > one. Skilled means skilled. Group means > > group. Supervised means > > supervised. You can rationalize as much as you want, > > but the meanings do > > not change. The only reason to go outside of the > > definitions would be > > (simply put) to increase profit, make more money, improve > > your financial > > bottom line. > > > > I may be a one man band singing this song, but I doubt it. > > > > Steve Marcum PT > > > > Outpatient Physical Therapy > > > > Lexington, KY, 40517 > > > > > > -- > > " Anyone who lives a sedentary life and does not exercise, > > even if he eats > > good foods and takes care of himself according to proper > > medical principles, > > all his days will be painful ones and his strength shall > > wane. " > > Maimonides, 1199 AD > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2011 Report Share Posted August 19, 2011 - I like the idea of having E and M codes similar to physicians, but just for clarification: * There are actually five levels of evaluation and management codes based on complexity of the visit, including the complexity of the decision making o In fact, level one codes are often under the supervision of the physician who may not actually see the patient, but rather the patient may be seen by support staff. When I teach my medical students about coding, I use the example of a patient coming in for a routine allergy shot. They are often given by CMAs or LPNs, and they are generally charged at a level 1. * There is a different code at each level for new patients vs. established patients; thus 10 codes total for the five different levels * There are situations in which additional codes can be billed [cid:image001.gif@...] Celebrating 45 years of education, research & outreach. Janice Kuperstein, PhD, PT Chair, Department of Rehabilitation Sciences Co-Director Family Medicine Clerkship University of Kentucky College of Health Sciences T. Wethington, Jr. Building, Rm 210A 900 South Limestone Lexington, KY 40536-0200 Phone: Fax: Administrative Associate : From: PTManager [mailto:PTManager ] On Behalf Of Ball Sent: Thursday, August 18, 2011 11:30 PM To: PTManager Subject: Re: PT Aides and 97110 , 97110 is a 1:1 code, not a group code. If you treated both patients concurrently for 16 minutes total, doing what amounts to 8 minutes of supervised and skilled " barking " at one while doing 8 minutes of manual therapy on the other - - - then sure, go ahead and bill each patient one unit, or a group code for each patient for the entire 16 minutes. The billing system that we have is, in my opinion, nonsense. Why don't we simply, like physicians, have two evaluation codes (basic and extended), and two treatment codes (basic and extended)? Clean. Not time dependent. Not tied to 1:1. Respecting our status as CLINICAL DOCTORS, simple, codes? M. Ball, PT, DPT, PhD Orthopedic Physical Therapy Resident Carolinas Rehabilitation Charlotte, NC On Thu, Aug 18, 2011 at 7:45 PM, scott hankins <skahank02@...<mailto:skahank02%40yahoo.com>> wrote: > ** > > > Since I started this very enlightening and productive " conversation " , I > want to chime in and give my 2 cents worth. > > PT aides/techs are being used today for various reasons. They clean, file > paperwork, apply hot/cold packs, get a modality cart, maybe apply the > modality on a patient, stand by a patient for safety reasons during > exercise, be a " voicepiece " for the PT during a pt exercise regimen when the > PT is doing manual therapy on the other side of the gym or because the PT > has to step out to take a phone call; well you get the point. > > There is no standardization for the job of being a PT aide! No common job > description for a PT aide, like there is for PT's and PTA's. > > We know what they can't do and that is provide skilled PT interventions > because they are not schooled and licensed to be a PT. I get that! > > So during a busy day when volume is high on everyones schedule (PT and PTA > alike) so the private practice clinic can make a meager profit (even with > well controlled expenses and cash pay services and decent payor mix) or just > to pay the bills in a reduced reimbursement era, the staff needs help from a > PT aide to keep the place moving smoothly and might have to help with > patient care AT TIMES. Not provide skilled care, but to help the PT or PTA > under their supervision. > > Now under this supervised care, does the PT code for services this PT aide, > " aided " , him or her with under their supervision? > > If I am doing a Maitland mob on a LBP pt, while supervising (line of sight > thing) my PT aide helping a pt do a bilateral squat w/o falling, all the > while I am barking out orders to make sure they are not taking their knees > beyond their toes, what do I do? Not code a 97110, or 97150 if it is a > Medicare pt, because the PT aide is standing by the pt for safety purposes? > I know I would not code it if I left for 15 min to make a phone call and > never watched the pt and PT aide interact. That is not skilled. But if I am > there in the same room as that PT aide and pt while providing care to > another pt, then I have a hard time seeing that as not a skilled service, > and not reimburseable. Especially if I evaluated the pt, know what's good > for them as far what skilled interventions to use, and allow the PT aide, to > aide me, in getting a pt through their visit safely, I would say that is > skilled care. It was my idea to do the squat exercise, my skilled mind, > making that happen, not the PT aides mind. > > I believe we as PTs should use judgement when coding so to honor and uphold > the spirit and integrity of what the code is designed to be used for. To > represent the skilled interventions we do a darn good job at when we take > our profession serious. > > We as PT clinic owners should only hire those people who make our > profession noble, filled with integrity, and respected. We should hire PTs, > PTAs, AND PT Aides/techs that help the clinic provide the best skilled > therapy possible and get paid a reasonable amount for it, with a good > margins, so I can eat some good steak every once in a while, take my > wonderful family to Disney World, and retire before I am 85! > > THOUGHTS??? > > Hankins, PT > Synergy Therapies, LLC > From: Ron Barbato <rbarbato@...<mailto:rbarbato%40emrmc.org>> > To: PTManager <mailto:PTManager%40yahoogroups.com> > Sent: Thursday, August 18, 2011 1:59 PM > > Subject: RE: PT Aides and 97110 > > > Your assumption is that the PT will be readily available and " see " each > patient prior to treatment. You and I know this will not be the case in all > situations. In that scenario the patient is at risk > Yes it does take the skill of a PT to assess and discern a POC, and yes it > does take skill of a PT to determine response to treatment and adjust , make > changes as needed. > If it were just about doing an US or performing exercise, We( PT) would not > be needed. > > Ron Barbato PT > > PRIVILEGED AND CONFIDENTIAL: This transmission may contain information that > is privileged subject to attorney-client privilege or attorney work product, > confidential and/or exempt from disclosure under applicable law. If you are > not the intended recipient, then please do not read it and be aware that any > disclosure, copying, distribution, or use of the information contained > herein (including any reliance thereon) is STRICTLY PROHIBITED. If you > received this transmission in error, please immediately advise me, by reply > e-mail, and delete this message and any attachments without retaining a copy > in any form. Thank you. > > RE: PT Aides and 97110 > > To: PTManager <mailto:PTManager%40yahoogroups.com> > > Date: Wednesday, August 17, 2011, 2:34 PM > > Aides Use or not use, which is the > > question. > > > > Ever since I first began following PTManager on this list > > serve, the > > concepts of productivity and use of extenders has been a > > strong topic for > > discussion. The contributions to the list serve on > > this topic usually fall > > into one of two categories. However, the crux of the > > issue is money; how to > > make as much as possible with the staffing and patient mix > > in your > > particular clinic. > > > > On the list serve I have observed the semantics and > > rationalizations by both > > sides of the issue. However, I never have seen anyone > > come out and say, " I > > use techs and or aides so I can do more than one patient at > > a time " . You > > know this is the reason. I know this is the reason. > > > > I have seen arguments stating that the government should > > not be telling me > > how I should run my practice. One argument being that > > " I deserve 100% > > autonomy and use my clinical outcomes to make my case for > > whether I can see > > more than one patient at a time " . The other side > > will argue that unless a > > PT or PTA delivers the service it is not skilled. > > Others state that it is > > the level of complexity that determines the criteria or > > whether or not it is > > skilled. > > > > I have patients report frequently, that they only see the > > therapist one > > time, are handed a set of exercises along with a timer, > > then shepherded to > > the gym where the patient reports being watched by a > > aide. The patient > > explains that the therapist goes away, many times to wave > > at them from > > across the room while working with another patient, > > sometimes never to > > return. Unfortunately the patient does not have > > knowledge of one on one > > codes, what skilled therapy means, nor any ideas of the 8 > > minute rules. The > > patient rarely complains about this, they simply do not > > return. > > > > Other times I have patient report wonderful therapists that > > took the time to > > do the manual work needed to restore function and decrease > > pain while > > describing their therapists as one that took the time to > > explain " the why " > > as well as " the what " of diagnosises that they needed > > to be understanding. > > > > The bottom line to my long winded diatribe is that as > > therapist we all know > > what the definitions of the codes are meant to be. > > One on one means one on > > one. Skilled means skilled. Group means > > group. Supervised means > > supervised. You can rationalize as much as you want, > > but the meanings do > > not change. The only reason to go outside of the > > definitions would be > > (simply put) to increase profit, make more money, improve > > your financial > > bottom line. > > > > I may be a one man band singing this song, but I doubt it. > > > > Steve Marcum PT > > > > Outpatient Physical Therapy > > > > Lexington, KY, 40517 > > > > > > -- > > " Anyone who lives a sedentary life and does not exercise, > > even if he eats > > good foods and takes care of himself according to proper > > medical principles, > > all his days will be painful ones and his strength shall > > wane. " > > Maimonides, 1199 AD > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 19, 2011 Report Share Posted August 19, 2011 I have been following this thread with quite a bit of interest, these are all topics that we have hashed over and over since the onset of this list serve. I am one of those who chooses to see all of my patients one on one, not because I have to, but because, after working for other people for ten years, in a wide variety of settings with differing productivity demands, I have found it in the best interest of my patients and of my sanity. I also realize that this patient care philosophy comes at a cost, both literally and figuratively and if the reimbursement does not at least meet the literal cost than I can't keep my doors open which does not serve either my patients or my sanity well. SO I DON'T SIGN CONTRACTS THAT DON'T MEET MY COSTS! In answer to Mr. Anonymous below, it is not, in my opinion, the " focus on one on one care " that is " killing our profession " . Instead, it is the willingness of those in power, those that sign contracts, those that chose, in years past, to devalue the Physical Therapy profession in the name of volume, those that chose to undercut their PT neighbors, offering insurance companies rates for PT visits that couldn't possibly meet their costs, in exchange for exclusivity, or volume. In attempt to meet the needs of that volume we saw the influx of the PT aide and other non-licensed personnel and the PT became the evaluator and the delegator. Nowhere is this more evident than in the work-comp world, the world where the patient doesn't have a voice, the world where, in the state of Florida at least, the state allows for reimbursement at 110% of the medicare fee schedule yet the PT, the provider of the care, is lucky to make 40% of that. Where does the rest of that money go, you ask? Surely not to the employer in terms of lower insurance premiums, no, it goes directly into the pocket of the guy that convinced you that it was in your best interest to accept what he had to offer in exchange for patient volume. The problem, then, is the other insurance companies and medicare look across the landscape and say, wait, he is able to provide the service for $40.00/visit, why can't you? We all want to say, well, he has 2 aides helping him see 4 people at a time while billing you for one on one care but we don't? Why not? Finally, Mr. Anonymous, if it is true that " time does not equal quality or ethics " I have to ask, where does it stop? The most gregarious example I reviewed in the recent past saw a PT, with no supportive personnel, see 14 patients from 8am to 11am, with an average billing of 3 units of " one on one " cpt codes per patient, that sir, is neither ethical nor quality. So where do you draw the line? Is it two at a time, three, four? How do you judge and how do you measure? For me it comes down to putting the patient first and treating them like I would expect to be treated, simple as that. E. s, PT, DPT, OCS, FAAOMPT www.douglasspt.com > > Posted on behalf of a PTManager who does not want to be ID'd > *************************************************************************** > > > Thanks Rick and others, > > The focus on one on one care is killing our profession and will be the final > nail in the coffin of our profession. > > Is it a skilled activity to have a PT or PTA stand by grandma and count her reps > so you can bill 97110 rather than group? The PT determined the need for the > activity, set the parameters of the exercise and fully observes it's set up by a > (you fill in the blank). > > We all hear, and repeat, how great we are but that clinic down the street > doesn't spend time with the patient, blah, blah, blah. Remember the knife cuts > both ways. For the respondents to this post and others in a similar vein I have > a few questions: Do you collect objective, standardized, risk adjusted outcomes > as well as patient satisfaction data? Justify your " quality of care " with data, > if you can't the rest is just hot air. Time does not equal quality or ethics. > > What about the OP clinics where the PT is there on a Monday doing evaluations > and PTA co-visits for the week not to return till the following Monday to do it > all over again. Who is making the program changes, progressions, modifications > when the PT is not on site for the remainder of the week? On the other hand the > OP clinic with a full time PT/owner, onsite 50 hours/week, with an aide or two. > This PT is in constant contact with knowledge of what each patient's status and > makes program changes daily. > > My heart goes out to the younger PT's that have huge student loans with > expectations of big salaries. My heart also goes out to the facilities whose > individual PT productivity doesn't " cover their nut " , " you want me to see >10 > visits/day and do an eval but what about the ethical one on one care? " Time does > not equal quality or ethics. The tipping point that our profession will be a > loss leader when health care contracts are signed is close at hand. > > Meanwhile, EP and ATC's do " functional testing " for cash with less training > quoting PT research to justify their conclusions. What do we do, " hey they > can't do that " . Yet these groups also get referrals from physicians for post op > " rehab " at your local gym. Why? Simple answer, many of us are too passive with > our interventions. What do we do as PTs? Complain and cry foul but are > unwilling to consider alternative practice settings or adding these skills to > our tool box. > > Quoting Norm from the old TV show CHEERS. " its a dog eat dog world out their and > I'm wearing milk bone shorts " . We are wearing the shorts and giving away more > milk bones. When are we going to turn around and take on the dogs? > > The leaders of our profession have put us into the " one on one treatment " box > which is completely unsustainable. Now its a mantra tied to quality and ethics. > Time does not equal quality or ethics. State boards are there to police the > fraud, overutilization, and improper care issues so let them. > > As a profession we need to raise our productivity, and consider alternative > practice settings to meet the needs of the consumer and market place, or lower > our expectations of pay and benefits. There are other groups out there more > than willing to step in for PT. Profit is not a bad thing but is hard to > justify the hours and stress for 6%. > > > > , I would ask that you withhold my name and email from this post. As a > fellow private practice clinician/owner in the killing fields day in and day out > for the past 20 years I feel that I am jousting with windmills some days. If you > can not withhold I understand, then do not post. We are far too passive as a > profession. > > > Quote Link to comment Share on other sites More sharing options...
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