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...
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...
Guest guest Posted August 19, 2011 Report Share Posted August 19, 2011 I would not raise my glass to anyone who posts anonymously - why post at all if you're not willing to accept responsibility for your words? As far as this focus on one-on-one care " killing our profession " - c'mon, you're being a bit dramatic, aren't you? The division of labor has always been the source of political division - just look at the annual fights over scope of practice among nurses, doctors, chiropractors and physical therapists that go on EVERY YEAR in state capitols around the nation. As the debate over heath care reform heats up these fights will only intensify. These debates aren't killing our profession - they invigorate it! Insofar as we can take one of two or more sides in any given issue, these debates help clarify our own positions. Where do you stand? Physical therapists should not be afraid to make known what we believe and where we stand, individually or as professionals. Thank you, Tim , PT www.PhysicalTherapyDiagnosis.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...
Guest guest Posted August 19, 2011 Report Share Posted August 19, 2011 I would not raise my glass to anyone who posts anonymously - why post at all if you're not willing to accept responsibility for your words? As far as this focus on one-on-one care " killing our profession " - c'mon, you're being a bit dramatic, aren't you? The division of labor has always been the source of political division - just look at the annual fights over scope of practice among nurses, doctors, chiropractors and physical therapists that go on EVERY YEAR in state capitols around the nation. As the debate over heath care reform heats up these fights will only intensify. These debates aren't killing our profession - they invigorate it! Insofar as we can take one of two or more sides in any given issue, these debates help clarify our own positions. Where do you stand? Physical therapists should not be afraid to make known what we believe and where we stand, individually or as professionals. Thank you, Tim , PT www.PhysicalTherapyDiagnosis.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...
Guest guest Posted August 19, 2011 Report Share Posted August 19, 2011 I would not raise my glass to anyone who posts anonymously - why post at all if you're not willing to accept responsibility for your words? As far as this focus on one-on-one care " killing our profession " - c'mon, you're being a bit dramatic, aren't you? The division of labor has always been the source of political division - just look at the annual fights over scope of practice among nurses, doctors, chiropractors and physical therapists that go on EVERY YEAR in state capitols around the nation. As the debate over heath care reform heats up these fights will only intensify. These debates aren't killing our profession - they invigorate it! Insofar as we can take one of two or more sides in any given issue, these debates help clarify our own positions. Where do you stand? Physical therapists should not be afraid to make known what we believe and where we stand, individually or as professionals. Thank you, Tim , PT www.PhysicalTherapyDiagnosis.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...
Guest guest Posted August 19, 2011 Report Share Posted August 19, 2011 Hi Steve, i have already made one long post on this thread so I'll keep this short, please don't take offense,just adding another perspective, you wrote: " Who is to judge the quality of the skill I'm providing to my LBP and my squatting pt? ME ya'll " and " 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 " I would disagree, and vehemently, because IT IS NOT YOU, nor the AMA, nor the APTA who determines the value or quality of your services IT IS THE PATIENT!!! and if I were patient A, i would not pay you my $40 co-pay to take my shirt off in the middle of your gym so you could poke on my low back pain, ESPECIALLY if you started barking orders to some high school kid across the gym while you were doing it. I would find somebody who respects my privacy more than that. and if I were patient B, I would not pay you my 20% co-insurance to do mini-squats while being watched by some high school kid, ESPECIALLY if you had to bark orders at him from across the gym to be sure that I was doing it right. I would find somebody who respects my wallet more than that. E. s, PT, DPT, OCS, FAAOMPT www.douglasspt.com > > > > > > > > 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 19, 2011 Report Share Posted August 19, 2011 Great idea!!!! How can we change it? Great thread. Thank you for the insight! Ruchin, PT, DPT Sent from my iPhone > , > > 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 Good point in general folks… How do we change? I will submit again what I think: 1) Good solid research supported by the profession to address the support personnel questions we have… Is it safe? Is it as effective and for what? Is it economically advantageous? 2) We have the collective guts to dump the AMA codes and develop our own billing codes and yes I am one of a growing ranks that sees the value in E & M codes as an example. This would also help us get paid for things we are trained in and should get paid for our true skill but cannot currently get paid for because there “is no code for itâ€. 3) If there is not the will or ability to develop our own codes, then let’s have a stronger push to bill using E & M codes as an example to get paid for those tasks that the research shows we can safely and effectively delegate to others (like the example of injections given) or for “incident to†type tasks. Please be assured that I would only support this IF there was research to support it (see # 1) 4) Let’s be the first to get away from billing based on volume and get to where everyone says we need to be but no-one, again, has the guts to go to-billing based on outcomes and quality NOT quantity. This may in itself, end the practice of the use of support personnel for treatment tasks if their use lowers quality measures (and payment). Conversely, it may also help: if research answers the questions (in # 1), then the use of support personnel could be used to keep quality measures up and may even help the business side of practice. We, collectively, have the answers but, so far, have not had the path to put them in place. Since there was talk this year and agreement that APTA Vision 2020 needs a little updating, I would submit that the heart of this discussion is an update to that vision that should and must be addressed. I would also submit that our current and future leaders keep working to address this (if they haven’t already). If we don’t answer the questions, they will continue to divide us and the more we are dividing the farther behind we will fall in the world of healthcare. With that in mind, yes, I agree that it ultimately is about our patients and getting them better. Let’s never forget that. 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. From: PTManager [mailto:PTManager ] On Behalf Of Ruchin Sent: Friday, August 19, 2011 12:04 PM To: PTManager Subject: Re: PT Aides and 97110 Great idea!!!! How can we change it? Great thread. Thank you for the insight! Ruchin, PT, DPT Sent from my iPhone On Aug 19, 2011, at 7:21 AM, " Ball " <drdrewpt@... <mailto:drdrewpt%40gmail.com> > wrote: > , > > 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 Good point in general folks… How do we change? I will submit again what I think: 1) Good solid research supported by the profession to address the support personnel questions we have… Is it safe? Is it as effective and for what? Is it economically advantageous? 2) We have the collective guts to dump the AMA codes and develop our own billing codes and yes I am one of a growing ranks that sees the value in E & M codes as an example. This would also help us get paid for things we are trained in and should get paid for our true skill but cannot currently get paid for because there “is no code for itâ€. 3) If there is not the will or ability to develop our own codes, then let’s have a stronger push to bill using E & M codes as an example to get paid for those tasks that the research shows we can safely and effectively delegate to others (like the example of injections given) or for “incident to†type tasks. Please be assured that I would only support this IF there was research to support it (see # 1) 4) Let’s be the first to get away from billing based on volume and get to where everyone says we need to be but no-one, again, has the guts to go to-billing based on outcomes and quality NOT quantity. This may in itself, end the practice of the use of support personnel for treatment tasks if their use lowers quality measures (and payment). Conversely, it may also help: if research answers the questions (in # 1), then the use of support personnel could be used to keep quality measures up and may even help the business side of practice. We, collectively, have the answers but, so far, have not had the path to put them in place. Since there was talk this year and agreement that APTA Vision 2020 needs a little updating, I would submit that the heart of this discussion is an update to that vision that should and must be addressed. I would also submit that our current and future leaders keep working to address this (if they haven’t already). If we don’t answer the questions, they will continue to divide us and the more we are dividing the farther behind we will fall in the world of healthcare. With that in mind, yes, I agree that it ultimately is about our patients and getting them better. Let’s never forget that. 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. From: PTManager [mailto:PTManager ] On Behalf Of Ruchin Sent: Friday, August 19, 2011 12:04 PM To: PTManager Subject: Re: PT Aides and 97110 Great idea!!!! How can we change it? Great thread. Thank you for the insight! Ruchin, PT, DPT Sent from my iPhone On Aug 19, 2011, at 7:21 AM, " Ball " <drdrewpt@... <mailto:drdrewpt%40gmail.com> > wrote: > , > > 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 Good point in general folks… How do we change? I will submit again what I think: 1) Good solid research supported by the profession to address the support personnel questions we have… Is it safe? Is it as effective and for what? Is it economically advantageous? 2) We have the collective guts to dump the AMA codes and develop our own billing codes and yes I am one of a growing ranks that sees the value in E & M codes as an example. This would also help us get paid for things we are trained in and should get paid for our true skill but cannot currently get paid for because there “is no code for itâ€. 3) If there is not the will or ability to develop our own codes, then let’s have a stronger push to bill using E & M codes as an example to get paid for those tasks that the research shows we can safely and effectively delegate to others (like the example of injections given) or for “incident to†type tasks. Please be assured that I would only support this IF there was research to support it (see # 1) 4) Let’s be the first to get away from billing based on volume and get to where everyone says we need to be but no-one, again, has the guts to go to-billing based on outcomes and quality NOT quantity. This may in itself, end the practice of the use of support personnel for treatment tasks if their use lowers quality measures (and payment). Conversely, it may also help: if research answers the questions (in # 1), then the use of support personnel could be used to keep quality measures up and may even help the business side of practice. We, collectively, have the answers but, so far, have not had the path to put them in place. Since there was talk this year and agreement that APTA Vision 2020 needs a little updating, I would submit that the heart of this discussion is an update to that vision that should and must be addressed. I would also submit that our current and future leaders keep working to address this (if they haven’t already). If we don’t answer the questions, they will continue to divide us and the more we are dividing the farther behind we will fall in the world of healthcare. With that in mind, yes, I agree that it ultimately is about our patients and getting them better. Let’s never forget that. 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. From: PTManager [mailto:PTManager ] On Behalf Of Ruchin Sent: Friday, August 19, 2011 12:04 PM To: PTManager Subject: Re: PT Aides and 97110 Great idea!!!! How can we change it? Great thread. Thank you for the insight! Ruchin, PT, DPT Sent from my iPhone On Aug 19, 2011, at 7:21 AM, " Ball " <drdrewpt@... <mailto:drdrewpt%40gmail.com> > wrote: > , > > 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 20, 2011 Report Share Posted August 20, 2011 The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. Carroll , PT Chattanooga TN 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 20, 2011 Report Share Posted August 20, 2011 The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. Carroll , PT Chattanooga TN 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 20, 2011 Report Share Posted August 20, 2011 The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. Carroll , PT Chattanooga TN 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 20, 2011 Report Share Posted August 20, 2011 Good point Carroll and one that must be said over and over. There is no doubt that the system of coding and billing as well as our own procedures of treatment must evolve and change with the healthcare market we practice in BUT and this is a BIG BUT… The current system allows treatment by support personnel ONLY in states where the practice act allows and ONLY by insurances that allow. Additionally CPT codes are specific in what one-on-one treatment is and who does it. Therefore those currently billing time for one-on-one codes for treatment done by support personnel are, under the current system, billing incorrectly and may be committing billing fraud especially if you are billing Medicare for treatment done by support personnel. Again, please do not confuse the issue of what we SHOULD be doing. This is simply a reminder that if you do not like the system we have, that does not allow free reign to bill incorrectly. AND as I have always added, there are plenty of inpatient departments, IRF’s, SNF’s, home health agencies and outpatient PT clinics that are billing correctly and are doing just fine economically. Follow their example for now and work to make the changes by being involved in your PT association at the state or national level or form your won lobbying group and push for the needed changes. 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. From: PTManager [mailto:PTManager ] On Behalf Of carrolllallen@... Sent: Saturday, August 20, 2011 10:18 AM To: PTManager Subject: Re: PT Aides and 97110 The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. Carroll , PT Chattanooga TN 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 20, 2011 Report Share Posted August 20, 2011 Good point Carroll and one that must be said over and over. There is no doubt that the system of coding and billing as well as our own procedures of treatment must evolve and change with the healthcare market we practice in BUT and this is a BIG BUT… The current system allows treatment by support personnel ONLY in states where the practice act allows and ONLY by insurances that allow. Additionally CPT codes are specific in what one-on-one treatment is and who does it. Therefore those currently billing time for one-on-one codes for treatment done by support personnel are, under the current system, billing incorrectly and may be committing billing fraud especially if you are billing Medicare for treatment done by support personnel. Again, please do not confuse the issue of what we SHOULD be doing. This is simply a reminder that if you do not like the system we have, that does not allow free reign to bill incorrectly. AND as I have always added, there are plenty of inpatient departments, IRF’s, SNF’s, home health agencies and outpatient PT clinics that are billing correctly and are doing just fine economically. Follow their example for now and work to make the changes by being involved in your PT association at the state or national level or form your won lobbying group and push for the needed changes. 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. From: PTManager [mailto:PTManager ] On Behalf Of carrolllallen@... Sent: Saturday, August 20, 2011 10:18 AM To: PTManager Subject: Re: PT Aides and 97110 The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. Carroll , PT Chattanooga TN 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 20, 2011 Report Share Posted August 20, 2011 Tom, Many of us agree 100+% with what you are saying. Unfortunately, in the business world there will always be " Bernie Madoffs " and " Raj Rajaratnams " who know the rules/regulations and yet still ignore them for their own personal gain. We have had years of proof that when physical therapy rules and contractual agreements change, there are people who quickly learn to exploit and or skirt them. I believe the APTA should strongly consider adding the requirement of CPT code and Medicare rule education to our current ethics relicensure requirements. PT schools should also include this type of correct billing education in their curriculum. Perhaps then, more PT's would report unscrupulous clinic managers/owners. Just my thoughts on the matter. Jon Mark Pleasant, PT > > > > Good point Carroll and one that must be said over and over. There is no doubt that the system of coding and billing as well as our own procedures of treatment must evolve and change with the healthcare market we practice in BUT and this is a BIG BUT… > > > > The current system allows treatment by support personnel ONLY in states where the practice act allows and ONLY by insurances that allow. Additionally CPT codes are specific in what one-on-one treatment is and who does it. Therefore those currently billing time for one-on-one codes for treatment done by support personnel are, under the current system, billing incorrectly and may be committing billing fraud especially if you are billing Medicare for treatment done by support personnel. > > > > Again, please do not confuse the issue of what we SHOULD be doing. This is simply a reminder that if you do not like the system we have, that does not allow free reign to bill incorrectly. AND as I have always added, there are plenty of inpatient departments, IRF’s, SNF’s, home health agencies and outpatient PT clinics that are billing correctly and are doing just fine economically. Follow their example for now and work to make the changes by being involved in your PT association at the state or national level or form your won lobbying group and push for the needed changes. > > > > 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. > > > > From: PTManager [mailto:PTManager ] On Behalf Of carrolllallen@... > Sent: Saturday, August 20, 2011 10:18 AM > To: PTManager > Subject: Re: PT Aides and 97110 > > > > > > > > The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. > > Carroll , PT > > Chattanooga TN > > 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 20, 2011 Report Share Posted August 20, 2011 Tom, Many of us agree 100+% with what you are saying. Unfortunately, in the business world there will always be " Bernie Madoffs " and " Raj Rajaratnams " who know the rules/regulations and yet still ignore them for their own personal gain. We have had years of proof that when physical therapy rules and contractual agreements change, there are people who quickly learn to exploit and or skirt them. I believe the APTA should strongly consider adding the requirement of CPT code and Medicare rule education to our current ethics relicensure requirements. PT schools should also include this type of correct billing education in their curriculum. Perhaps then, more PT's would report unscrupulous clinic managers/owners. Just my thoughts on the matter. Jon Mark Pleasant, PT > > > > Good point Carroll and one that must be said over and over. There is no doubt that the system of coding and billing as well as our own procedures of treatment must evolve and change with the healthcare market we practice in BUT and this is a BIG BUT… > > > > The current system allows treatment by support personnel ONLY in states where the practice act allows and ONLY by insurances that allow. Additionally CPT codes are specific in what one-on-one treatment is and who does it. Therefore those currently billing time for one-on-one codes for treatment done by support personnel are, under the current system, billing incorrectly and may be committing billing fraud especially if you are billing Medicare for treatment done by support personnel. > > > > Again, please do not confuse the issue of what we SHOULD be doing. This is simply a reminder that if you do not like the system we have, that does not allow free reign to bill incorrectly. AND as I have always added, there are plenty of inpatient departments, IRF’s, SNF’s, home health agencies and outpatient PT clinics that are billing correctly and are doing just fine economically. Follow their example for now and work to make the changes by being involved in your PT association at the state or national level or form your won lobbying group and push for the needed changes. > > > > 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. > > > > From: PTManager [mailto:PTManager ] On Behalf Of carrolllallen@... > Sent: Saturday, August 20, 2011 10:18 AM > To: PTManager > Subject: Re: PT Aides and 97110 > > > > > > > > The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. > > Carroll , PT > > Chattanooga TN > > 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 20, 2011 Report Share Posted August 20, 2011 How do we change the CPT code definitions? Does PT-PAC do it, or do we work through the state level, then to the federal level? I know in today's healthcare market, we are seeing a decline in reimbursements. The MPPR, the possible ~ 30% reduction in Medicare reimbursements next year, etc, is making us all realize these definitions of one on one is pigeon-holing us into a tight spot. One on one does not cover our costs, or give us adeguate margins on the visit.  We can run a tight ship, but costs of providing quality care; ie - on site pool therapy or any other major investment that increases the value of our treatment, are driving us private practice owners to rethink how we schedule, how we treat (EBM - based of course), what we purchase, and how to create other revenue streams.  I say raise our reimbursement rates, then we can do more one on one. Or better yet, pay us for quality (incentivizing us to invest more $ into what we do to get the pt better faster), not quantity. Then everyone is happy (pt, provider, owner, payor, etc), not for the sake of getting wealthy but to make an honest living, even in today's tight economy.  Hankins, PT Synergy Therapies, LLC To: PTManager Sent: Saturday, August 20, 2011 11:17 AM Subject: Re: PT Aides and 97110  The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. Carroll , PT Chattanooga TN 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 20, 2011 Report Share Posted August 20, 2011 How do we change the CPT code definitions? Does PT-PAC do it, or do we work through the state level, then to the federal level? I know in today's healthcare market, we are seeing a decline in reimbursements. The MPPR, the possible ~ 30% reduction in Medicare reimbursements next year, etc, is making us all realize these definitions of one on one is pigeon-holing us into a tight spot. One on one does not cover our costs, or give us adeguate margins on the visit.  We can run a tight ship, but costs of providing quality care; ie - on site pool therapy or any other major investment that increases the value of our treatment, are driving us private practice owners to rethink how we schedule, how we treat (EBM - based of course), what we purchase, and how to create other revenue streams.  I say raise our reimbursement rates, then we can do more one on one. Or better yet, pay us for quality (incentivizing us to invest more $ into what we do to get the pt better faster), not quantity. Then everyone is happy (pt, provider, owner, payor, etc), not for the sake of getting wealthy but to make an honest living, even in today's tight economy.  Hankins, PT Synergy Therapies, LLC To: PTManager Sent: Saturday, August 20, 2011 11:17 AM Subject: Re: PT Aides and 97110  The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. Carroll , PT Chattanooga TN 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 21, 2011 Report Share Posted August 21, 2011 , Speed bump #1 APTA vs. AMA: I'm not sure how much influence the APTA has on the AMA. Convincing the AMA that radical changes in the physical medicine and rehab CPT definitions are needed would likely be a steep uphill battle. However, that doesn't mean it is not worth the effort for APTA members to suggest this to our representative leadership. A well organized petition might be a good first step. Objectively, if you look at the APTAs statement against POPTS and the progress (or lack thereof) they have made over the last 28 years in efforts to eliminate them, you might get a glimpse of a similar kind of uphill battle we would face in attempts to " revamp " the CPT definitions. An article from 2005 titled An American Physical Therapy Association White Paper: Position on Physician-Owned Physical Therapy Services (POPTS) gives a little background regarding the APTAs stance and effort to eliminate POPTS. Bottom line: 28 years later, POPTS still exist and are growing in number. One might conclude that the APTAs fight has been less than effective. At least they continue the fight! Link: http://aptaco.org/POPTS%20White%20Paper%20final.pdf Speed bump #2 Third party payers: Convincing third party payers to increase their reimbursement amounts would seem to be an even steeper uphill battle (or a pipe dream). Third party payers benefit from continuous reductions in reimbursement rates, allowable visits, and total allowed coverage amounts. In addition, they benefit from making it as difficult as possible for providers to submit and receive payment for their services. There is just no incentive for them to be a participant in simplifying our coding or billing processes let alone increasing reimbursement. Speed bump #3 Pay for performance: Below is a link from M.D.s perspective that discusses a few of the difficulties that would be encountered with a " Pay for Performance " (PFP) system. On the surface, PFP may sound like a good idea. However, creating and implementing a functioning PFP system would be quite daunting both in time and expense. Third party payers would be the creator and manager of such a program not PTs and we already know where their motivation lies. It's far easier and less costly for them to simply keep cutting reimbursement and passing on more cost to the consumer. Have you noticed this trend? Even if PFP programs are eventually implemented, one might wonder who bears the responsibility of the metrics tracking and if the potential 1-2% increase in reimbursement will be offset by the increased effort required for compliance. I can assure you, insurance companies do not want a net decrease in their profits to result from a PFP program. PFP will not be a windfall for PTs. Pay for Performance article Link: http://www.healthways.co.uk/newsroom/articles/Managing%20the%20Metric%20vs%20Man\ aging%20the%20Patient.pdf Lastly, I feel I must apologize for the apparent negativity of this post. I would like to think I'm a " glass half full " type of person. My statements are based mostly on retrospective observation of the APTAs effectiveness with POPTS and the trending of third party payers over the last 20+ years. In time, cash based services may start looking better and better when compared to declining third party reimbursements. 1. No long waits for a protracted APTA fight against the more powerful lobby of the AMA, 2. No CPT restrictions 3. No restraints from contractual agreements (Medicare). The only restraint would seem to be the creativity of the PT business owner. Jon Mark Pleasant, PT > > How do we change the CPT code definitions? Does PT-PAC do it, or do we work through the state level, then to the federal level? I know in today's healthcare market, we are seeing a decline in reimbursements. The MPPR, the possible ~ 30% reduction in Medicare reimbursements next year, etc, is making us all realize these definitions of one on one is pigeon-holing us into a tight spot. One on one does not cover our costs, or give us adeguate margins on the visit. >  > We can run a tight ship, but costs of providing quality care; ie - on site pool therapy or any other major investment that increases the value of our treatment, are driving us private practice owners to rethink how we schedule, how we treat (EBM - based of course), what we purchase, and how to create other revenue streams. >  > I say raise our reimbursement rates, then we can do more one on one. Or better yet, pay us for quality (incentivizing us to invest more $ into what we do to get the pt better faster), not quantity. Then everyone is happy (pt, provider, owner, payor, etc), not for the sake of getting wealthy but to make an honest living, even in today's tight economy. >  > Hankins, PT > Synergy Therapies, LLC > > > To: PTManager > Sent: Saturday, August 20, 2011 11:17 AM > Subject: Re: PT Aides and 97110 > > >  > > > > The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. > > Carroll , PT > > Chattanooga TN > > 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 21, 2011 Report Share Posted August 21, 2011 , Speed bump #1 APTA vs. AMA: I'm not sure how much influence the APTA has on the AMA. Convincing the AMA that radical changes in the physical medicine and rehab CPT definitions are needed would likely be a steep uphill battle. However, that doesn't mean it is not worth the effort for APTA members to suggest this to our representative leadership. A well organized petition might be a good first step. Objectively, if you look at the APTAs statement against POPTS and the progress (or lack thereof) they have made over the last 28 years in efforts to eliminate them, you might get a glimpse of a similar kind of uphill battle we would face in attempts to " revamp " the CPT definitions. An article from 2005 titled An American Physical Therapy Association White Paper: Position on Physician-Owned Physical Therapy Services (POPTS) gives a little background regarding the APTAs stance and effort to eliminate POPTS. Bottom line: 28 years later, POPTS still exist and are growing in number. One might conclude that the APTAs fight has been less than effective. At least they continue the fight! Link: http://aptaco.org/POPTS%20White%20Paper%20final.pdf Speed bump #2 Third party payers: Convincing third party payers to increase their reimbursement amounts would seem to be an even steeper uphill battle (or a pipe dream). Third party payers benefit from continuous reductions in reimbursement rates, allowable visits, and total allowed coverage amounts. In addition, they benefit from making it as difficult as possible for providers to submit and receive payment for their services. There is just no incentive for them to be a participant in simplifying our coding or billing processes let alone increasing reimbursement. Speed bump #3 Pay for performance: Below is a link from M.D.s perspective that discusses a few of the difficulties that would be encountered with a " Pay for Performance " (PFP) system. On the surface, PFP may sound like a good idea. However, creating and implementing a functioning PFP system would be quite daunting both in time and expense. Third party payers would be the creator and manager of such a program not PTs and we already know where their motivation lies. It's far easier and less costly for them to simply keep cutting reimbursement and passing on more cost to the consumer. Have you noticed this trend? Even if PFP programs are eventually implemented, one might wonder who bears the responsibility of the metrics tracking and if the potential 1-2% increase in reimbursement will be offset by the increased effort required for compliance. I can assure you, insurance companies do not want a net decrease in their profits to result from a PFP program. PFP will not be a windfall for PTs. Pay for Performance article Link: http://www.healthways.co.uk/newsroom/articles/Managing%20the%20Metric%20vs%20Man\ aging%20the%20Patient.pdf Lastly, I feel I must apologize for the apparent negativity of this post. I would like to think I'm a " glass half full " type of person. My statements are based mostly on retrospective observation of the APTAs effectiveness with POPTS and the trending of third party payers over the last 20+ years. In time, cash based services may start looking better and better when compared to declining third party reimbursements. 1. No long waits for a protracted APTA fight against the more powerful lobby of the AMA, 2. No CPT restrictions 3. No restraints from contractual agreements (Medicare). The only restraint would seem to be the creativity of the PT business owner. Jon Mark Pleasant, PT > > How do we change the CPT code definitions? Does PT-PAC do it, or do we work through the state level, then to the federal level? I know in today's healthcare market, we are seeing a decline in reimbursements. The MPPR, the possible ~ 30% reduction in Medicare reimbursements next year, etc, is making us all realize these definitions of one on one is pigeon-holing us into a tight spot. One on one does not cover our costs, or give us adeguate margins on the visit. >  > We can run a tight ship, but costs of providing quality care; ie - on site pool therapy or any other major investment that increases the value of our treatment, are driving us private practice owners to rethink how we schedule, how we treat (EBM - based of course), what we purchase, and how to create other revenue streams. >  > I say raise our reimbursement rates, then we can do more one on one. Or better yet, pay us for quality (incentivizing us to invest more $ into what we do to get the pt better faster), not quantity. Then everyone is happy (pt, provider, owner, payor, etc), not for the sake of getting wealthy but to make an honest living, even in today's tight economy. >  > Hankins, PT > Synergy Therapies, LLC > > > To: PTManager > Sent: Saturday, August 20, 2011 11:17 AM > Subject: Re: PT Aides and 97110 > > >  > > > > The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. > > Carroll , PT > > Chattanooga TN > > 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 21, 2011 Report Share Posted August 21, 2011 , Speed bump #1 APTA vs. AMA: I'm not sure how much influence the APTA has on the AMA. Convincing the AMA that radical changes in the physical medicine and rehab CPT definitions are needed would likely be a steep uphill battle. However, that doesn't mean it is not worth the effort for APTA members to suggest this to our representative leadership. A well organized petition might be a good first step. Objectively, if you look at the APTAs statement against POPTS and the progress (or lack thereof) they have made over the last 28 years in efforts to eliminate them, you might get a glimpse of a similar kind of uphill battle we would face in attempts to " revamp " the CPT definitions. An article from 2005 titled An American Physical Therapy Association White Paper: Position on Physician-Owned Physical Therapy Services (POPTS) gives a little background regarding the APTAs stance and effort to eliminate POPTS. Bottom line: 28 years later, POPTS still exist and are growing in number. One might conclude that the APTAs fight has been less than effective. At least they continue the fight! Link: http://aptaco.org/POPTS%20White%20Paper%20final.pdf Speed bump #2 Third party payers: Convincing third party payers to increase their reimbursement amounts would seem to be an even steeper uphill battle (or a pipe dream). Third party payers benefit from continuous reductions in reimbursement rates, allowable visits, and total allowed coverage amounts. In addition, they benefit from making it as difficult as possible for providers to submit and receive payment for their services. There is just no incentive for them to be a participant in simplifying our coding or billing processes let alone increasing reimbursement. Speed bump #3 Pay for performance: Below is a link from M.D.s perspective that discusses a few of the difficulties that would be encountered with a " Pay for Performance " (PFP) system. On the surface, PFP may sound like a good idea. However, creating and implementing a functioning PFP system would be quite daunting both in time and expense. Third party payers would be the creator and manager of such a program not PTs and we already know where their motivation lies. It's far easier and less costly for them to simply keep cutting reimbursement and passing on more cost to the consumer. Have you noticed this trend? Even if PFP programs are eventually implemented, one might wonder who bears the responsibility of the metrics tracking and if the potential 1-2% increase in reimbursement will be offset by the increased effort required for compliance. I can assure you, insurance companies do not want a net decrease in their profits to result from a PFP program. PFP will not be a windfall for PTs. Pay for Performance article Link: http://www.healthways.co.uk/newsroom/articles/Managing%20the%20Metric%20vs%20Man\ aging%20the%20Patient.pdf Lastly, I feel I must apologize for the apparent negativity of this post. I would like to think I'm a " glass half full " type of person. My statements are based mostly on retrospective observation of the APTAs effectiveness with POPTS and the trending of third party payers over the last 20+ years. In time, cash based services may start looking better and better when compared to declining third party reimbursements. 1. No long waits for a protracted APTA fight against the more powerful lobby of the AMA, 2. No CPT restrictions 3. No restraints from contractual agreements (Medicare). The only restraint would seem to be the creativity of the PT business owner. Jon Mark Pleasant, PT > > How do we change the CPT code definitions? Does PT-PAC do it, or do we work through the state level, then to the federal level? I know in today's healthcare market, we are seeing a decline in reimbursements. The MPPR, the possible ~ 30% reduction in Medicare reimbursements next year, etc, is making us all realize these definitions of one on one is pigeon-holing us into a tight spot. One on one does not cover our costs, or give us adeguate margins on the visit. >  > We can run a tight ship, but costs of providing quality care; ie - on site pool therapy or any other major investment that increases the value of our treatment, are driving us private practice owners to rethink how we schedule, how we treat (EBM - based of course), what we purchase, and how to create other revenue streams. >  > I say raise our reimbursement rates, then we can do more one on one. Or better yet, pay us for quality (incentivizing us to invest more $ into what we do to get the pt better faster), not quantity. Then everyone is happy (pt, provider, owner, payor, etc), not for the sake of getting wealthy but to make an honest living, even in today's tight economy. >  > Hankins, PT > Synergy Therapies, LLC > > > To: PTManager > Sent: Saturday, August 20, 2011 11:17 AM > Subject: Re: PT Aides and 97110 > > >  > > > > The definition for certain billing codes is one-on-one treatment. If we do not deliver one-on-one services yet bill that code is it not fraudulent billing? If we want to do more than one-on-one then the code must be changed. At least that seems to ultimately be the crux of the matter. > > Carroll , PT > > Chattanooga TN > > 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 23, 2011 Report Share Posted August 23, 2011 Regarding the " anonymous " post segment on performance of " functional testing " .... I spend time in a number of settings with different staffing models and am often asked about " who can do what " in the areas of occupational health, prework screens, and FCEs. While the practice area may seem narrower than what is being discussed in this thread, the principles likely carry over a bit. (but are never a substitute for you licensing board :-) Some folks tell me " well I heard about a place where the PT did the intake eval portion of a FCE and then handed off to the ATC for the functional testing, they can do this in this state " . When I ask why the PT is even involved if the non- PT licensee can do the testing independently, I am often left with a blank stare. If the licensure laws allow an licensee to perform an evaluative process under their own license, they should be able to do the whole thing and accept all legal/malpractice elements of that care. Under most state practice acts, anyone working under a PT (other than a PTA) is an aide and neither can perform things that are evaluative. Subsequent comments usually related usually come around to the non-PT provider wanting the PT to " clear them " (and accept responsibility). I won't wade into the debate on " therex " at this time, others are doing quite well, but " how I feel about it " is different from " what can be done based on the circumstances " if the practice model and laws allow. They may be simple, but there are a few simple questions to keep " in our lanes " or " keep the lanes clear " Is the licensee working " under " a PT or " under their own license " and are P & Ps fully consistent with this? What does the licensure law allow? If they are working with a different licensee designation, are they carried on the facility malpractice And/or do they carry personal coverage)? What level of interaction (evaluative, screen, direct care, modalities)? From a practice owner perspective there could be money to be made by setting up " service lines " that are not necessarily physical therapy based (clinics have PT/OT/ST/fitness lines, etc. service lines), they need not necessarily " conflict " with the practice of PT. From a practitioner stand point, we largely choose to work in clinics whose model aligns with our values as much as possible. I also am " educated " on occasion about a " team " model of some combination of PT/PTA/ATC/other, with perspective that this is " best practice " . One example of discussion points is that " if trained appropriately (based on their professional organization), it should be ok to delegate " manual therapy " as an example. If we truly have a PT led " team " , shouldn't the highest level skills be performed by the highest level professional on the team. I would argue for things such as manipulation as a simple example would rise to that level. Does the " best practice model " say that the therapist should be involved at some point in every encounter to perform those higher level interventions/ongoing evaluative process or can the team " just split up the patient load " ? <<Anonymous Poster snippet>> 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. Random thoughts on a Tuesday, Dee Dee Daley, PT, DPT Southern Pines, NC Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 23, 2011 Report Share Posted August 23, 2011 Regarding the " anonymous " post segment on performance of " functional testing " .... I spend time in a number of settings with different staffing models and am often asked about " who can do what " in the areas of occupational health, prework screens, and FCEs. While the practice area may seem narrower than what is being discussed in this thread, the principles likely carry over a bit. (but are never a substitute for you licensing board :-) Some folks tell me " well I heard about a place where the PT did the intake eval portion of a FCE and then handed off to the ATC for the functional testing, they can do this in this state " . When I ask why the PT is even involved if the non- PT licensee can do the testing independently, I am often left with a blank stare. If the licensure laws allow an licensee to perform an evaluative process under their own license, they should be able to do the whole thing and accept all legal/malpractice elements of that care. Under most state practice acts, anyone working under a PT (other than a PTA) is an aide and neither can perform things that are evaluative. Subsequent comments usually related usually come around to the non-PT provider wanting the PT to " clear them " (and accept responsibility). I won't wade into the debate on " therex " at this time, others are doing quite well, but " how I feel about it " is different from " what can be done based on the circumstances " if the practice model and laws allow. They may be simple, but there are a few simple questions to keep " in our lanes " or " keep the lanes clear " Is the licensee working " under " a PT or " under their own license " and are P & Ps fully consistent with this? What does the licensure law allow? If they are working with a different licensee designation, are they carried on the facility malpractice And/or do they carry personal coverage)? What level of interaction (evaluative, screen, direct care, modalities)? From a practice owner perspective there could be money to be made by setting up " service lines " that are not necessarily physical therapy based (clinics have PT/OT/ST/fitness lines, etc. service lines), they need not necessarily " conflict " with the practice of PT. From a practitioner stand point, we largely choose to work in clinics whose model aligns with our values as much as possible. I also am " educated " on occasion about a " team " model of some combination of PT/PTA/ATC/other, with perspective that this is " best practice " . One example of discussion points is that " if trained appropriately (based on their professional organization), it should be ok to delegate " manual therapy " as an example. If we truly have a PT led " team " , shouldn't the highest level skills be performed by the highest level professional on the team. I would argue for things such as manipulation as a simple example would rise to that level. Does the " best practice model " say that the therapist should be involved at some point in every encounter to perform those higher level interventions/ongoing evaluative process or can the team " just split up the patient load " ? <<Anonymous Poster snippet>> 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. Random thoughts on a Tuesday, Dee Dee Daley, PT, DPT Southern Pines, NC Quote Link to comment Share on other sites More sharing options...
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