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

>>

>>