Re: Thoughts From a Utilization Reviewer #2: Numbers

[Guest guest]

Dear Alan: I would agree to Damon that if you could point out what we

have to look out for, it would be greatly appreciated. Every PT I have

known has decided to get into the profession to help their fellow

beings and it seems like RACs and other ins. entities make us look

like we are common criminals. No PT goes into the profession to make

obscene amounts of money like Apple or Google. As Puzo stated:

Behind every big money is big crime!

Hiten Dave PT

> Is that something that you can point us (practicing PTs)

> In a direction to get better understanding and

> To increase our vocabulary for medical

> Necessity and maybe some examples of

> What you have seen as reviewers (good

> And bad) for us to look at?

>

> Thanks

>

> Damon C. Whitfield PT, ATC

> Tim Bondy Physical Therapy

> 930 S. State St. Suite 10

> (office)

> (fax)

>

> On Mar 19, 2012, at 9:35 AM, Gerry Stone

> wrote:

>

>> Alan,

>> Your observations from your PT chart audits are dead on. We do utilization

>> rehab reviews from all over the country. What's make the therapists most

>> vulnerable is their lack of ability to convey Medical Necessity or even

>> understand what that means. RAC auditors will be having a field day with

>> PT clinics when they get fully cranked up. It's sad and scary for the

>> profession.

>>

>> Gerry Stone, PT, M.Ed.

>> President / Founder

>> ReDoc Software

>>

>> From: PTManager [mailto:PTManager ] On

>> Behalf Of Alan Petrazzi

>> Sent: Sunday, March 18, 2012 6:01 PM

>> To: hpa-list ; PTManager

>> Subject: Thoughts From a Utilization Reviewer #2: Numbers

>>

>> I mentioned before that part of my duties include being the utilization

>> reviewer of hundreds of community PTs from three states. This email is the

>> second edition of a similar email I sent a few months ago.

>> NUMBERS

>> These are curious trends that I see in almost every note or evaluation. It

>> doesn't matter what practice, zip code, provider demographics or terminal

>> degree. I am really interested to learn 'why' this is happening. Where did

>> this originate? Why is it so pervasive? Honestly -- does it originate in

>> the course work, is it passed down through the PT generations, what are

>> the reasons?

>> Frequency -- 3 times a week. (Alternate 2-3). Never 1. Never tapered or

>> stepped up/down across the weeks. Just a straight 3x.Scheduling -- M-W-F

>> or T-Th. Why? I presume the clinical answer is to give a day of rest but

>> still...is this what EVERY clinician EVERYWHERE believes?Duration -- 4

>> weeks. Sometimes 6. Never 3. Never 5. Never 7. Never 2.5.Repetitions --

>> 10. Sometimes 20 or 25. Never 30. Never 35. " Do ten, take a break, and do

>> ten more then take a break and do ten more. " How about doing reps until

>> the quality/form degrades and then noting this. You might find it the real

>> number was 17. Pain goal to 0-10. Really? Patient has had pain for 20

>> years. If an exacerbation took their pain to 7/10, it's o.k. to write

>> realistic goals to achieve the patient's tolerable level of pain. Maybe it

>> is a 3/10. Visit management -- when a PT requests 3 x 4 = 12 and is

>> authorized 8 visits, why doesn't the PT manage the

>> sessions differently, i.e. 2 x 4 or 3, 2, 2, 1? Doesn't happen. They stick

>> with 3 x a week and run out at 2.5 weeks and then ask for 12 more. Not

>> once. Every time.My Commentary -- very few PTs are skilled at discussing

>> cases with utilization reviewers. Too often they use secretaries as front

>> line intermediaries to secure more visits (faxed letters from the office

>> manager with " this is the second request! " ). When I talk to a PT it is

>> often as if I have 4 heads for having the gall to ask them where they are

>> taking this POC now they're at visit 12 with 11 copy & pasted notes. Be

>> calm, make your professional case, demonstrate your skill to the reviewer

>> and the reviewer will be more confident in the services you render to our

>> beneficiary.

>> Thanks for reading. Looking forward to your insight.

>> These are my thoughts and may not reflect the opinions of my employer. I

>> am sending this out as a private citizen.

>> Alan Petrazzi, MPT, MPM

>> Rehab DirectorPittsburgh, PA

>>

>>

[Guest guest]

Dan / Hiten,

I hear your frustration with the concept of having to justify payment and prove

the value of our services through time consuming documentation. To Hiten

comments about " RACs and other ins. entities make us look like we are common

criminals " is painfully true. Some PTs (a few bad apples) have made and are

still making a lot of money off of defrauding Medicare and 3rd party payers.

The OIG ranks PT right up there with chiropractors and other blatant abusers of

the system. Therefore, our documentation will be scrutinized and these auditors

make a percentage on what clinics have to pay back. IT is serious business, but

we can fight back.

If your documentation conveys Medical Necessity or why this patient needed the

skill and education of a PT to progress in a functional activity you should be

fine (see some suggestion below). The issues the Alan points out, (i.e., never

a change in frequency, duration, sets, reps with intermittent assessment

explaining any rational for modifying or not modifying the treatment) is an

indication that the services may not have been medically necessary. " Cloned

medical records " have emerged in the electronic medical records world as a major

red flag for auditors. Since the information flows from the previous note to

today's note, the temptation to simply sign and print is great. Don't do it,

take a few minutes to update each note. They are now talking about Pre-pay

audits, where they look at your documentation before they pay you.

Here are some other ideas on conveying Medical Necessity:

* The APTA's position on Defining Medical Necessity...

http://www.apta.org/Payment/PrivateInsurance/DefiningMedicallyNecessary/

* Convey in the IE how your plan is going to improve the patient's

quality of life or reduce the burden of care at home. Track these goals

throughout the treatment cycle.

* Communicate your critical thinking process in making clinical

decisions.

* Indicate your unique skills as a therapist with ongoing justification

of interventions and education at the impairment AND functional activity levels

* Provide information that therapy is consistent with the diagnosis and

patient need; services are specific/effective to this patient and diagnosis; and

that there are reasonable expectations that observable and measurable

improvements will be met

I hope this helps and it gets a little easier to do what we love the most -

treating patients.

Gerry Stone, PT, M.Ed.

President / Founder

ReDoc Software

From: PTManager [mailto:PTManager ] On Behalf Of

Sent: Monday, March 19, 2012 11:14 PM

To: PTManager

Subject: Re: Thoughts From a Utilization Reviewer #2: Numbers

I am scratching my head and rereading the post offered by my colleagues asking

for help in determining what it is that RAC auditors are looking for? " Is that

something that you can point us (practicing PTs)In a direction to get better

understanding and To increase our vocabulary for medical Necessity and maybe

some examples of what you have seen as reviewers (good

And bad) for us to look at? "

With all do respect: what school that graduates post doc PT's ; MS or BS in PT

and IS NOT TEACHING documentation of skilled treatment and medical necessity? We

are in serious doo doo as Alan and Gerry are trying to convey. Their lack of

reply leads me to believe that they are extremely frustrated, but please forgive

me for assuming that. I often make as A@@ of myself when I assume.

Alan's piece lists the things that are troubling. These need to be addressed in

documentation.

Watch your frequency and reasoning. Don't use a cookbook of 3xwk. Instead of

treating a guy with 6 PT visits at 3w2 go for 2 in a row to teach a HEP, follow

up with a phone call later in the week and explain it is the clients

responsibility to be compliant with the HEP and to report back for progression

in a week. You dont need a PT to baby sit the ex each and every session. This is

what is wrong with our practice. 3 x wk with the same 20 reps or clam shells

over and over progressing with an extra set or two each session. That can be

done telephonically many times. If a need arises on the phone that needs to be

addressed have the client come in. Explain why 8-20 reps was done, use a 1RM,

don't go over 20 as the best practice states, explain how the form degrades or

failure was achieved. Document pain on a scale or RPE. Don't simply write gait

10' with fww and max assist. Explain the needs for the skilled professional

intervention of a PT, otherwise a CNA or volunteer at the hospital can do it.

Taking excellent courses at the National convention or State conventions or

Arnie Cisnero among others will help you understand this, but an online CEU

won't cut it.

What RAC and ZPIC are looking at specifically is not something I can personally

share but I do know skilled intervention and medical necessity.

Finally, the statement that since we dont make big money " RACs and other ins.

entities make us look like we are common criminals. " Are you trying to say that

stealing a dollar isn't as serious as stealing 10000? Every time you add 5

minutes of unskilled time to a beneficiaries charge sheet that is stealing. It

adds up. The common thief on the street who just got caught shoplifting can make

the same argument that " man give me a break, My PT today sat around and talked

about Payton Manning while I rode a stationary bike for 20 minutes. That wasn't

skilled care and I know that cost more than this 10$ pair of sunglasses! "

With hope for our profession,

Dan Huddart PT GCS

> >

> >> Alan,

> >> Your observations from your PT chart audits are dead on. We do utilization

> >> rehab reviews from all over the country. What's make the therapists most

> >> vulnerable is their lack of ability to convey Medical Necessity or even

> >> understand what that means. RAC auditors will be having a field day with

> >> PT clinics when they get fully cranked up. It's sad and scary for the

> >> profession.

> >>

> >> Gerry Stone, PT, M.Ed.

> >> President / Founder

> >> ReDoc Software

> >>

> >> From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On

> >> Behalf Of Alan Petrazzi

> >> Sent: Sunday, March 18, 2012 6:01 PM

> >> To: hpa-list <mailto:hpa-list%40yahoogroups.com>;

PTManager <mailto:PTManager%40yahoogroups.com>

> >> Subject: Thoughts From a Utilization Reviewer #2: Numbers

> >>

> >> I mentioned before that part of my duties include being the utilization

> >> reviewer of hundreds of community PTs from three states. This email is the

> >> second edition of a similar email I sent a few months ago.

> >> NUMBERS

> >> These are curious trends that I see in almost every note or evaluation. It

> >> doesn't matter what practice, zip code, provider demographics or terminal

> >> degree. I am really interested to learn 'why' this is happening. Where did

> >> this originate? Why is it so pervasive? Honestly -- does it originate in

> >> the course work, is it passed down through the PT generations, what are

> >> the reasons?

> >> Frequency -- 3 times a week. (Alternate 2-3). Never 1. Never tapered or

> >> stepped up/down across the weeks. Just a straight 3x.Scheduling -- M-W-F

> >> or T-Th. Why? I presume the clinical answer is to give a day of rest but

> >> still...is this what EVERY clinician EVERYWHERE believes?Duration -- 4

> >> weeks. Sometimes 6. Never 3. Never 5. Never 7. Never 2.5.Repetitions --

> >> 10. Sometimes 20 or 25. Never 30. Never 35. " Do ten, take a break, and do

> >> ten more then take a break and do ten more. " How about doing reps until

> >> the quality/form degrades and then noting this. You might find it the real

> >> number was 17. Pain goal to 0-10. Really? Patient has had pain for 20

> >> years. If an exacerbation took their pain to 7/10, it's o.k. to write

> >> realistic goals to achieve the patient's tolerable level of pain. Maybe it

> >> is a 3/10. Visit management -- when a PT requests 3 x 4 = 12 and is

> >> authorized 8 visits, why doesn't the PT manage the

> >> sessions differently, i.e. 2 x 4 or 3, 2, 2, 1? Doesn't happen. They stick

> >> with 3 x a week and run out at 2.5 weeks and then ask for 12 more. Not

> >> once. Every time.My Commentary -- very few PTs are skilled at discussing

> >> cases with utilization reviewers. Too often they use secretaries as front

> >> line intermediaries to secure more visits (faxed letters from the office

> >> manager with " this is the second request! " ). When I talk to a PT it is

> >> often as if I have 4 heads for having the gall to ask them where they are

> >> taking this POC now they're at visit 12 with 11 copy & pasted notes. Be

> >> calm, make your professional case, demonstrate your skill to the reviewer

> >> and the reviewer will be more confident in the services you render to our

> >> beneficiary.

> >> Thanks for reading. Looking forward to your insight.

> >> These are my thoughts and may not reflect the opinions of my employer. I

> >> am sending this out as a private citizen.

> >> Alan Petrazzi, MPT, MPM

> >> Rehab DirectorPittsburgh, PA

> >>

> >>

[Guest guest]

Dan / Hiten,

I hear your frustration with the concept of having to justify payment and prove

the value of our services through time consuming documentation. To Hiten

comments about " RACs and other ins. entities make us look like we are common

criminals " is painfully true. Some PTs (a few bad apples) have made and are

still making a lot of money off of defrauding Medicare and 3rd party payers.

The OIG ranks PT right up there with chiropractors and other blatant abusers of

the system. Therefore, our documentation will be scrutinized and these auditors

make a percentage on what clinics have to pay back. IT is serious business, but

we can fight back.

If your documentation conveys Medical Necessity or why this patient needed the

skill and education of a PT to progress in a functional activity you should be

fine (see some suggestion below). The issues the Alan points out, (i.e., never

a change in frequency, duration, sets, reps with intermittent assessment

explaining any rational for modifying or not modifying the treatment) is an

indication that the services may not have been medically necessary. " Cloned

medical records " have emerged in the electronic medical records world as a major

red flag for auditors. Since the information flows from the previous note to

today's note, the temptation to simply sign and print is great. Don't do it,

take a few minutes to update each note. They are now talking about Pre-pay

audits, where they look at your documentation before they pay you.

Here are some other ideas on conveying Medical Necessity:

* The APTA's position on Defining Medical Necessity...

http://www.apta.org/Payment/PrivateInsurance/DefiningMedicallyNecessary/

* Convey in the IE how your plan is going to improve the patient's

quality of life or reduce the burden of care at home. Track these goals

throughout the treatment cycle.

* Communicate your critical thinking process in making clinical

decisions.

* Indicate your unique skills as a therapist with ongoing justification

of interventions and education at the impairment AND functional activity levels

* Provide information that therapy is consistent with the diagnosis and

patient need; services are specific/effective to this patient and diagnosis; and

that there are reasonable expectations that observable and measurable

improvements will be met

I hope this helps and it gets a little easier to do what we love the most -

treating patients.

Gerry Stone, PT, M.Ed.

President / Founder

ReDoc Software

From: PTManager [mailto:PTManager ] On Behalf Of

Sent: Monday, March 19, 2012 11:14 PM

To: PTManager

Subject: Re: Thoughts From a Utilization Reviewer #2: Numbers

I am scratching my head and rereading the post offered by my colleagues asking

for help in determining what it is that RAC auditors are looking for? " Is that

something that you can point us (practicing PTs)In a direction to get better

understanding and To increase our vocabulary for medical Necessity and maybe

some examples of what you have seen as reviewers (good

And bad) for us to look at? "

With all do respect: what school that graduates post doc PT's ; MS or BS in PT

and IS NOT TEACHING documentation of skilled treatment and medical necessity? We

are in serious doo doo as Alan and Gerry are trying to convey. Their lack of

reply leads me to believe that they are extremely frustrated, but please forgive

me for assuming that. I often make as A@@ of myself when I assume.

Alan's piece lists the things that are troubling. These need to be addressed in

documentation.

Watch your frequency and reasoning. Don't use a cookbook of 3xwk. Instead of

treating a guy with 6 PT visits at 3w2 go for 2 in a row to teach a HEP, follow

up with a phone call later in the week and explain it is the clients

responsibility to be compliant with the HEP and to report back for progression

in a week. You dont need a PT to baby sit the ex each and every session. This is

what is wrong with our practice. 3 x wk with the same 20 reps or clam shells

over and over progressing with an extra set or two each session. That can be

done telephonically many times. If a need arises on the phone that needs to be

addressed have the client come in. Explain why 8-20 reps was done, use a 1RM,

don't go over 20 as the best practice states, explain how the form degrades or

failure was achieved. Document pain on a scale or RPE. Don't simply write gait

10' with fww and max assist. Explain the needs for the skilled professional

intervention of a PT, otherwise a CNA or volunteer at the hospital can do it.

Taking excellent courses at the National convention or State conventions or

Arnie Cisnero among others will help you understand this, but an online CEU

won't cut it.

What RAC and ZPIC are looking at specifically is not something I can personally

share but I do know skilled intervention and medical necessity.

Finally, the statement that since we dont make big money " RACs and other ins.

entities make us look like we are common criminals. " Are you trying to say that

stealing a dollar isn't as serious as stealing 10000? Every time you add 5

minutes of unskilled time to a beneficiaries charge sheet that is stealing. It

adds up. The common thief on the street who just got caught shoplifting can make

the same argument that " man give me a break, My PT today sat around and talked

about Payton Manning while I rode a stationary bike for 20 minutes. That wasn't

skilled care and I know that cost more than this 10$ pair of sunglasses! "

With hope for our profession,

Dan Huddart PT GCS

> >

> >> Alan,

> >> Your observations from your PT chart audits are dead on. We do utilization

> >> rehab reviews from all over the country. What's make the therapists most

> >> vulnerable is their lack of ability to convey Medical Necessity or even

> >> understand what that means. RAC auditors will be having a field day with

> >> PT clinics when they get fully cranked up. It's sad and scary for the

> >> profession.

> >>

> >> Gerry Stone, PT, M.Ed.

> >> President / Founder

> >> ReDoc Software

> >>

> >> From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On

> >> Behalf Of Alan Petrazzi

> >> Sent: Sunday, March 18, 2012 6:01 PM

> >> To: hpa-list <mailto:hpa-list%40yahoogroups.com>;

PTManager <mailto:PTManager%40yahoogroups.com>

> >> Subject: Thoughts From a Utilization Reviewer #2: Numbers

> >>

> >> I mentioned before that part of my duties include being the utilization

> >> reviewer of hundreds of community PTs from three states. This email is the

> >> second edition of a similar email I sent a few months ago.

> >> NUMBERS

> >> These are curious trends that I see in almost every note or evaluation. It

> >> doesn't matter what practice, zip code, provider demographics or terminal

> >> degree. I am really interested to learn 'why' this is happening. Where did

> >> this originate? Why is it so pervasive? Honestly -- does it originate in

> >> the course work, is it passed down through the PT generations, what are

> >> the reasons?

> >> Frequency -- 3 times a week. (Alternate 2-3). Never 1. Never tapered or

> >> stepped up/down across the weeks. Just a straight 3x.Scheduling -- M-W-F

> >> or T-Th. Why? I presume the clinical answer is to give a day of rest but

> >> still...is this what EVERY clinician EVERYWHERE believes?Duration -- 4

> >> weeks. Sometimes 6. Never 3. Never 5. Never 7. Never 2.5.Repetitions --

> >> 10. Sometimes 20 or 25. Never 30. Never 35. " Do ten, take a break, and do

> >> ten more then take a break and do ten more. " How about doing reps until

> >> the quality/form degrades and then noting this. You might find it the real

> >> number was 17. Pain goal to 0-10. Really? Patient has had pain for 20

> >> years. If an exacerbation took their pain to 7/10, it's o.k. to write

> >> realistic goals to achieve the patient's tolerable level of pain. Maybe it

> >> is a 3/10. Visit management -- when a PT requests 3 x 4 = 12 and is

> >> authorized 8 visits, why doesn't the PT manage the

> >> sessions differently, i.e. 2 x 4 or 3, 2, 2, 1? Doesn't happen. They stick

> >> with 3 x a week and run out at 2.5 weeks and then ask for 12 more. Not

> >> once. Every time.My Commentary -- very few PTs are skilled at discussing

> >> cases with utilization reviewers. Too often they use secretaries as front

> >> line intermediaries to secure more visits (faxed letters from the office

> >> manager with " this is the second request! " ). When I talk to a PT it is

> >> often as if I have 4 heads for having the gall to ask them where they are

> >> taking this POC now they're at visit 12 with 11 copy & pasted notes. Be

> >> calm, make your professional case, demonstrate your skill to the reviewer

> >> and the reviewer will be more confident in the services you render to our

> >> beneficiary.

> >> Thanks for reading. Looking forward to your insight.

> >> These are my thoughts and may not reflect the opinions of my employer. I

> >> am sending this out as a private citizen.

> >> Alan Petrazzi, MPT, MPM

> >> Rehab DirectorPittsburgh, PA

> >>

> >>

[Guest guest]

Dan / Hiten,

I hear your frustration with the concept of having to justify payment and prove

the value of our services through time consuming documentation. To Hiten

comments about " RACs and other ins. entities make us look like we are common

criminals " is painfully true. Some PTs (a few bad apples) have made and are

still making a lot of money off of defrauding Medicare and 3rd party payers.

The OIG ranks PT right up there with chiropractors and other blatant abusers of

the system. Therefore, our documentation will be scrutinized and these auditors

make a percentage on what clinics have to pay back. IT is serious business, but

we can fight back.

If your documentation conveys Medical Necessity or why this patient needed the

skill and education of a PT to progress in a functional activity you should be

fine (see some suggestion below). The issues the Alan points out, (i.e., never

a change in frequency, duration, sets, reps with intermittent assessment

explaining any rational for modifying or not modifying the treatment) is an

indication that the services may not have been medically necessary. " Cloned

medical records " have emerged in the electronic medical records world as a major

red flag for auditors. Since the information flows from the previous note to

today's note, the temptation to simply sign and print is great. Don't do it,

take a few minutes to update each note. They are now talking about Pre-pay

audits, where they look at your documentation before they pay you.

Here are some other ideas on conveying Medical Necessity:

* The APTA's position on Defining Medical Necessity...

http://www.apta.org/Payment/PrivateInsurance/DefiningMedicallyNecessary/

* Convey in the IE how your plan is going to improve the patient's

quality of life or reduce the burden of care at home. Track these goals

throughout the treatment cycle.

* Communicate your critical thinking process in making clinical

decisions.

* Indicate your unique skills as a therapist with ongoing justification

of interventions and education at the impairment AND functional activity levels

* Provide information that therapy is consistent with the diagnosis and

patient need; services are specific/effective to this patient and diagnosis; and

that there are reasonable expectations that observable and measurable

improvements will be met

I hope this helps and it gets a little easier to do what we love the most -

treating patients.

Gerry Stone, PT, M.Ed.

President / Founder

ReDoc Software

From: PTManager [mailto:PTManager ] On Behalf Of

Sent: Monday, March 19, 2012 11:14 PM

To: PTManager

Subject: Re: Thoughts From a Utilization Reviewer #2: Numbers

I am scratching my head and rereading the post offered by my colleagues asking

for help in determining what it is that RAC auditors are looking for? " Is that

something that you can point us (practicing PTs)In a direction to get better

understanding and To increase our vocabulary for medical Necessity and maybe

some examples of what you have seen as reviewers (good

And bad) for us to look at? "

With all do respect: what school that graduates post doc PT's ; MS or BS in PT

and IS NOT TEACHING documentation of skilled treatment and medical necessity? We

are in serious doo doo as Alan and Gerry are trying to convey. Their lack of

reply leads me to believe that they are extremely frustrated, but please forgive

me for assuming that. I often make as A@@ of myself when I assume.

Alan's piece lists the things that are troubling. These need to be addressed in

documentation.

Watch your frequency and reasoning. Don't use a cookbook of 3xwk. Instead of

treating a guy with 6 PT visits at 3w2 go for 2 in a row to teach a HEP, follow

up with a phone call later in the week and explain it is the clients

responsibility to be compliant with the HEP and to report back for progression

in a week. You dont need a PT to baby sit the ex each and every session. This is

what is wrong with our practice. 3 x wk with the same 20 reps or clam shells

over and over progressing with an extra set or two each session. That can be

done telephonically many times. If a need arises on the phone that needs to be

addressed have the client come in. Explain why 8-20 reps was done, use a 1RM,

don't go over 20 as the best practice states, explain how the form degrades or

failure was achieved. Document pain on a scale or RPE. Don't simply write gait

10' with fww and max assist. Explain the needs for the skilled professional

intervention of a PT, otherwise a CNA or volunteer at the hospital can do it.

Taking excellent courses at the National convention or State conventions or

Arnie Cisnero among others will help you understand this, but an online CEU

won't cut it.

What RAC and ZPIC are looking at specifically is not something I can personally

share but I do know skilled intervention and medical necessity.

Finally, the statement that since we dont make big money " RACs and other ins.

entities make us look like we are common criminals. " Are you trying to say that

stealing a dollar isn't as serious as stealing 10000? Every time you add 5

minutes of unskilled time to a beneficiaries charge sheet that is stealing. It

adds up. The common thief on the street who just got caught shoplifting can make

the same argument that " man give me a break, My PT today sat around and talked

about Payton Manning while I rode a stationary bike for 20 minutes. That wasn't

skilled care and I know that cost more than this 10$ pair of sunglasses! "

With hope for our profession,

Dan Huddart PT GCS

> >

> >> Alan,

> >> Your observations from your PT chart audits are dead on. We do utilization

> >> rehab reviews from all over the country. What's make the therapists most

> >> vulnerable is their lack of ability to convey Medical Necessity or even

> >> understand what that means. RAC auditors will be having a field day with

> >> PT clinics when they get fully cranked up. It's sad and scary for the

> >> profession.

> >>

> >> Gerry Stone, PT, M.Ed.

> >> President / Founder

> >> ReDoc Software

> >>

> >> From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com>] On

> >> Behalf Of Alan Petrazzi

> >> Sent: Sunday, March 18, 2012 6:01 PM

> >> To: hpa-list <mailto:hpa-list%40yahoogroups.com>;

PTManager <mailto:PTManager%40yahoogroups.com>

> >> Subject: Thoughts From a Utilization Reviewer #2: Numbers

> >>

> >> I mentioned before that part of my duties include being the utilization

> >> reviewer of hundreds of community PTs from three states. This email is the

> >> second edition of a similar email I sent a few months ago.

> >> NUMBERS

> >> These are curious trends that I see in almost every note or evaluation. It

> >> doesn't matter what practice, zip code, provider demographics or terminal

> >> degree. I am really interested to learn 'why' this is happening. Where did

> >> this originate? Why is it so pervasive? Honestly -- does it originate in

> >> the course work, is it passed down through the PT generations, what are

> >> the reasons?

> >> Frequency -- 3 times a week. (Alternate 2-3). Never 1. Never tapered or

> >> stepped up/down across the weeks. Just a straight 3x.Scheduling -- M-W-F

> >> or T-Th. Why? I presume the clinical answer is to give a day of rest but

> >> still...is this what EVERY clinician EVERYWHERE believes?Duration -- 4

> >> weeks. Sometimes 6. Never 3. Never 5. Never 7. Never 2.5.Repetitions --

> >> 10. Sometimes 20 or 25. Never 30. Never 35. " Do ten, take a break, and do

> >> ten more then take a break and do ten more. " How about doing reps until

> >> the quality/form degrades and then noting this. You might find it the real

> >> number was 17. Pain goal to 0-10. Really? Patient has had pain for 20

> >> years. If an exacerbation took their pain to 7/10, it's o.k. to write

> >> realistic goals to achieve the patient's tolerable level of pain. Maybe it

> >> is a 3/10. Visit management -- when a PT requests 3 x 4 = 12 and is

> >> authorized 8 visits, why doesn't the PT manage the

> >> sessions differently, i.e. 2 x 4 or 3, 2, 2, 1? Doesn't happen. They stick

> >> with 3 x a week and run out at 2.5 weeks and then ask for 12 more. Not

> >> once. Every time.My Commentary -- very few PTs are skilled at discussing

> >> cases with utilization reviewers. Too often they use secretaries as front

> >> line intermediaries to secure more visits (faxed letters from the office

> >> manager with " this is the second request! " ). When I talk to a PT it is

> >> often as if I have 4 heads for having the gall to ask them where they are

> >> taking this POC now they're at visit 12 with 11 copy & pasted notes. Be

> >> calm, make your professional case, demonstrate your skill to the reviewer

> >> and the reviewer will be more confident in the services you render to our

> >> beneficiary.

> >> Thanks for reading. Looking forward to your insight.

> >> These are my thoughts and may not reflect the opinions of my employer. I

> >> am sending this out as a private citizen.

> >> Alan Petrazzi, MPT, MPM

> >> Rehab DirectorPittsburgh, PA

> >>

> >>