Thoughts From a Utilization Reviewer #2: Numbers

March 18, 2012

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

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