Re: Thoughts From a Utilization Reviewer #2: Numbers

[Guest guest]

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]

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)

> 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]

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]

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 ] 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

> >>

> >>