Treating a patient without a written plan of care?

[Guest guest]

Hello, I need advice with the following issue.

I have one therapist who is always very far behind on his notes, so we can't

bill for them.

Example it takes over 15 days to do the report for Initial Eval, but patient is

coming 3 times per week, this means we have initial eval plus 6 notes behind.

Can you treat a patient without having a written plan of care?

Which actions do you suggest?

In advance thanks for any advice that help to solve this painful situation.

Vallejos

High Five Physical Therapy

[Guest guest]

Change his compensation package to be reflective of timely documentation.

Three strikes and you're out?

Give him a pathway and rationale of all of the ramifications of delayed billing

and see how he responds to that

For two weeks give him two extra hours during the week for documentation and if

he can't get everything done by an agreed-upon time and date that other measures

need to be taken

Just a couple thoughts. Good luck on resolving this issue, I know that can be

frustrating and difficult for cash flow

Damon C. Whitfield PT, ATC

Tim Bondy Physical Therapy

930 S. State St. Suite 10

(office)

(fax)

> Hello, I need advice with the following issue.

> I have one therapist who is always very far behind on his notes, so we can't

bill for them.

>

> Example it takes over 15 days to do the report for Initial Eval, but patient

is coming 3 times per week, this means we have initial eval plus 6 notes behind.

>

> Can you treat a patient without having a written plan of care?

> Which actions do you suggest?

>

> In advance thanks for any advice that help to solve this painful situation.

>

> Vallejos

> High Five Physical Therapy

>

>

>

>

>

>

>

[Guest guest]

In 17 years of practice, the most I have ever been is 48 hours behind. A

therapist 15 days behind can't possibly be documenting accurately. That then

becomes a liability for your entire clinic for a whole host of reasons.

In my mind, this would most certainly fall into the category of progressive

discipline. Probably serious enough to warrant a written warning with a

time-specific corrective action plan.

M. Ball, PT, DPT, PhD

Northeast Rehabilitation Gateway

Carolinas Rehabilitation

Orthopedic PT Residency Faculty

Charlotte/Concord, NC

> Hello, I need advice with the following issue.

> I have one therapist who is always very far behind on his notes, so we can't

bill for them.

>

> Example it takes over 15 days to do the report for Initial Eval, but patient

is coming 3 times per week, this means we have initial eval plus 6 notes behind.

>

> Can you treat a patient without having a written plan of care?

> Which actions do you suggest?

>

> In advance thanks for any advice that help to solve this painful situation.

>

> Vallejos

> High Five Physical Therapy

>

>

[Guest guest]

Remember that if you’re documenting today for what happened three weeks ago,

you still have to date it TODAY, and that the note reflects the date in the

past. If not dated TODAY, it can be considered fraudulent documentation and

subject to (at best) denial of the claim or (at worst) a hefty fine.

Wendland PT

Ohio

From: PTManager [mailto:PTManager ] On Behalf Of

Ball

Sent: Wednesday, June 06, 2012 9:30 PM

To: PTManager

Subject: Re: Treating a patient without a written plan of care?

In 17 years of practice, the most I have ever been is 48 hours behind. A

therapist 15 days behind can't possibly be documenting accurately. That then

becomes a liability for your entire clinic for a whole host of reasons.

In my mind, this would most certainly fall into the category of progressive

discipline. Probably serious enough to warrant a written warning with a

time-specific corrective action plan.

M. Ball, PT, DPT, PhD

Northeast Rehabilitation Gateway

Carolinas Rehabilitation

Orthopedic PT Residency Faculty

Charlotte/Concord, NC

On Jun 6, 2012, at 8:28 PM, " vallejos " <jose@... <mailto:jose%40hi5pt.com>

> wrote:

> Hello, I need advice with the following issue.

> I have one therapist who is always very far behind on his notes, so we can't

bill for them.

>

> Example it takes over 15 days to do the report for Initial Eval, but patient

is coming 3 times per week, this means we have initial eval plus 6 notes behind.

>

> Can you treat a patient without having a written plan of care?

> Which actions do you suggest?

>

> In advance thanks for any advice that help to solve this painful situation.

>

> Vallejos

> High Five Physical Therapy

>

>

[Guest guest]

This therapist is a huge liability for your practice.

I have worked with several with this type of behavior.

From my experience, I would suggest you give them a short period of time to get

caught up. If they don't comply and stay caught up, cut them loose.

The ones I have worked with, although self-proclaimed " great therapists " , were

not a bargain at any price. Unfortunately, we did not find that out until after

they left.

The good news, they are now destroying someone else's practice - not ours.

Tough decisions. Good luck

Kovacek

>

> Hello, I need advice with the following issue.

> I have one therapist who is always very far behind on his notes, so we can't

bill for them.

>

> Example it takes over 15 days to do the report for Initial Eval, but patient

is coming 3 times per week, this means we have initial eval plus 6 notes behind.

>

> Can you treat a patient without having a written plan of care?

> Which actions do you suggest?

>

> In advance thanks for any advice that help to solve this painful situation.

>

> Vallejos

> High Five Physical Therapy

>

[Guest guest]

This therapist is a huge liability for your practice.

I have worked with several with this type of behavior.

From my experience, I would suggest you give them a short period of time to get

caught up. If they don't comply and stay caught up, cut them loose.

The ones I have worked with, although self-proclaimed " great therapists " , were

not a bargain at any price. Unfortunately, we did not find that out until after

they left.

The good news, they are now destroying someone else's practice - not ours.

Tough decisions. Good luck

Kovacek

>

> Hello, I need advice with the following issue.

> I have one therapist who is always very far behind on his notes, so we can't

bill for them.

>

> Example it takes over 15 days to do the report for Initial Eval, but patient

is coming 3 times per week, this means we have initial eval plus 6 notes behind.

>

> Can you treat a patient without having a written plan of care?

> Which actions do you suggest?

>

> In advance thanks for any advice that help to solve this painful situation.

>

> Vallejos

> High Five Physical Therapy

>

[Guest guest]

Hello,

I would recommend you create an Action Plan for this individual and put

timelines for completion in effect immediately, today. This employee is a

liability to your practice and your reputation.

These things are not easy, but a necessity . We have termed folks on issues like

this. Sad but true.

E. Lynn MS PT

Director of Rehabilitation

Marlton Rehabilitation Hospital

92 Brick Rd.

Marlton, NJ 08055

ext 4204

From: PTManager [mailto:PTManager ] On Behalf Of

Ball

Sent: Wednesday, June 06, 2012 9:30 PM

To: PTManager

Subject: Re: Treating a patient without a written plan of care?

In 17 years of practice, the most I have ever been is 48 hours behind. A

therapist 15 days behind can't possibly be documenting accurately. That then

becomes a liability for your entire clinic for a whole host of reasons.

In my mind, this would most certainly fall into the category of progressive

discipline. Probably serious enough to warrant a written warning with a

time-specific corrective action plan.

M. Ball, PT, DPT, PhD

Northeast Rehabilitation Gateway

Carolinas Rehabilitation

Orthopedic PT Residency Faculty

Charlotte/Concord, NC

On Jun 6, 2012, at 8:28 PM, " vallejos " <jose@...<mailto:jose%40hi5pt.com>>

wrote:

> Hello, I need advice with the following issue.

> I have one therapist who is always very far behind on his notes, so we can't

bill for them.

>

> Example it takes over 15 days to do the report for Initial Eval, but patient

is coming 3 times per week, this means we have initial eval plus 6 notes behind.

>

> Can you treat a patient without having a written plan of care?

> Which actions do you suggest?

>

> In advance thanks for any advice that help to solve this painful situation.

>

> Vallejos

> High Five Physical Therapy

>

>

[Guest guest]

Hello,

I would recommend you create an Action Plan for this individual and put

timelines for completion in effect immediately, today. This employee is a

liability to your practice and your reputation.

These things are not easy, but a necessity . We have termed folks on issues like

this. Sad but true.

E. Lynn MS PT

Director of Rehabilitation

Marlton Rehabilitation Hospital

92 Brick Rd.

Marlton, NJ 08055

ext 4204

From: PTManager [mailto:PTManager ] On Behalf Of

Ball

Sent: Wednesday, June 06, 2012 9:30 PM

To: PTManager

Subject: Re: Treating a patient without a written plan of care?

In 17 years of practice, the most I have ever been is 48 hours behind. A

therapist 15 days behind can't possibly be documenting accurately. That then

becomes a liability for your entire clinic for a whole host of reasons.

In my mind, this would most certainly fall into the category of progressive

discipline. Probably serious enough to warrant a written warning with a

time-specific corrective action plan.

M. Ball, PT, DPT, PhD

Northeast Rehabilitation Gateway

Carolinas Rehabilitation

Orthopedic PT Residency Faculty

Charlotte/Concord, NC

On Jun 6, 2012, at 8:28 PM, " vallejos " <jose@...<mailto:jose%40hi5pt.com>>

wrote:

> Hello, I need advice with the following issue.

> I have one therapist who is always very far behind on his notes, so we can't

bill for them.

>

> Example it takes over 15 days to do the report for Initial Eval, but patient

is coming 3 times per week, this means we have initial eval plus 6 notes behind.

>

> Can you treat a patient without having a written plan of care?

> Which actions do you suggest?

>

> In advance thanks for any advice that help to solve this painful situation.

>

> Vallejos

> High Five Physical Therapy

>

>

[Guest guest]

Hello,

I would recommend you create an Action Plan for this individual and put

timelines for completion in effect immediately, today. This employee is a

liability to your practice and your reputation.

These things are not easy, but a necessity . We have termed folks on issues like

this. Sad but true.

E. Lynn MS PT

Director of Rehabilitation

Marlton Rehabilitation Hospital

92 Brick Rd.

Marlton, NJ 08055

ext 4204

From: PTManager [mailto:PTManager ] On Behalf Of

Ball

Sent: Wednesday, June 06, 2012 9:30 PM

To: PTManager

Subject: Re: Treating a patient without a written plan of care?

In 17 years of practice, the most I have ever been is 48 hours behind. A

therapist 15 days behind can't possibly be documenting accurately. That then

becomes a liability for your entire clinic for a whole host of reasons.

In my mind, this would most certainly fall into the category of progressive

discipline. Probably serious enough to warrant a written warning with a

time-specific corrective action plan.

M. Ball, PT, DPT, PhD

Northeast Rehabilitation Gateway

Carolinas Rehabilitation

Orthopedic PT Residency Faculty

Charlotte/Concord, NC

On Jun 6, 2012, at 8:28 PM, " vallejos " <jose@...<mailto:jose%40hi5pt.com>>

wrote:

> Hello, I need advice with the following issue.

> I have one therapist who is always very far behind on his notes, so we can't

bill for them.

>

> Example it takes over 15 days to do the report for Initial Eval, but patient

is coming 3 times per week, this means we have initial eval plus 6 notes behind.

>

> Can you treat a patient without having a written plan of care?

> Which actions do you suggest?

>

> In advance thanks for any advice that help to solve this painful situation.

>

> Vallejos

> High Five Physical Therapy

>

>

[Guest guest]

I completely agree. I had a similar scenario occur here not too long ago, and

that person is no longer employed here.. even after being given several chances

to catch up. I also guarantee that no matter how many notes this therapists

“claims†to have left to do… I would double that figure. This is not

professional behavior and definitely warrants disciplinary action. If your staff

is salaried, there is no reason you cannot also require that he “stay until

the work is done.†This might mean working several hours a day after patient

care is over, until the notes are caught up.

Best of luck. (15 days for an eval?? Yikes!)

Weiss, PT, MPT

Director, Rehabilitation Services

Schwab Rehabilitation Hospital

Mount Sinai Hospital

jennifer.weiss@...

Phone:

Fax:

From: PTManager [mailto:PTManager ] On Behalf Of

Ball

Sent: Wednesday, June 06, 2012 8:30 PM

To: PTManager

Subject: Re: Treating a patient without a written plan of care?

In 17 years of practice, the most I have ever been is 48 hours behind. A

therapist 15 days behind can't possibly be documenting accurately. That then

becomes a liability for your entire clinic for a whole host of reasons.

In my mind, this would most certainly fall into the category of progressive

discipline. Probably serious enough to warrant a written warning with a

time-specific corrective action plan.

M. Ball, PT, DPT, PhD

Northeast Rehabilitation Gateway

Carolinas Rehabilitation

Orthopedic PT Residency Faculty

Charlotte/Concord, NC

On Jun 6, 2012, at 8:28 PM, " vallejos " <jose@...<mailto:jose%40hi5pt.com>>

wrote:

> Hello, I need advice with the following issue.

> I have one therapist who is always very far behind on his notes, so we can't

bill for them.

>

> Example it takes over 15 days to do the report for Initial Eval, but patient

is coming 3 times per week, this means we have initial eval plus 6 notes behind.

>

> Can you treat a patient without having a written plan of care?

> Which actions do you suggest?

>

> In advance thanks for any advice that help to solve this painful situation.

>

> Vallejos

> High Five Physical Therapy

>

>

[Guest guest]

I completely agree. I had a similar scenario occur here not too long ago, and

that person is no longer employed here.. even after being given several chances

to catch up. I also guarantee that no matter how many notes this therapists

“claims†to have left to do… I would double that figure. This is not

professional behavior and definitely warrants disciplinary action. If your staff

is salaried, there is no reason you cannot also require that he “stay until

the work is done.†This might mean working several hours a day after patient

care is over, until the notes are caught up.

Best of luck. (15 days for an eval?? Yikes!)

Weiss, PT, MPT

Director, Rehabilitation Services

Schwab Rehabilitation Hospital

Mount Sinai Hospital

jennifer.weiss@...

Phone:

Fax:

From: PTManager [mailto:PTManager ] On Behalf Of

Ball

Sent: Wednesday, June 06, 2012 8:30 PM

To: PTManager

Subject: Re: Treating a patient without a written plan of care?

In 17 years of practice, the most I have ever been is 48 hours behind. A

therapist 15 days behind can't possibly be documenting accurately. That then

becomes a liability for your entire clinic for a whole host of reasons.

In my mind, this would most certainly fall into the category of progressive

discipline. Probably serious enough to warrant a written warning with a

time-specific corrective action plan.

M. Ball, PT, DPT, PhD

Northeast Rehabilitation Gateway

Carolinas Rehabilitation

Orthopedic PT Residency Faculty

Charlotte/Concord, NC

On Jun 6, 2012, at 8:28 PM, " vallejos " <jose@...<mailto:jose%40hi5pt.com>>

wrote:

> Hello, I need advice with the following issue.

> I have one therapist who is always very far behind on his notes, so we can't

bill for them.

>

> Example it takes over 15 days to do the report for Initial Eval, but patient

is coming 3 times per week, this means we have initial eval plus 6 notes behind.

>

> Can you treat a patient without having a written plan of care?

> Which actions do you suggest?

>

> In advance thanks for any advice that help to solve this painful situation.

>

> Vallejos

> High Five Physical Therapy

>

>

[Guest guest]

I completely agree. I had a similar scenario occur here not too long ago, and

that person is no longer employed here.. even after being given several chances

to catch up. I also guarantee that no matter how many notes this therapists

“claims†to have left to do… I would double that figure. This is not

professional behavior and definitely warrants disciplinary action. If your staff

is salaried, there is no reason you cannot also require that he “stay until

the work is done.†This might mean working several hours a day after patient

care is over, until the notes are caught up.

Best of luck. (15 days for an eval?? Yikes!)

Weiss, PT, MPT

Director, Rehabilitation Services

Schwab Rehabilitation Hospital

Mount Sinai Hospital

jennifer.weiss@...

Phone:

Fax:

From: PTManager [mailto:PTManager ] On Behalf Of

Ball

Sent: Wednesday, June 06, 2012 8:30 PM

To: PTManager

Subject: Re: Treating a patient without a written plan of care?

In 17 years of practice, the most I have ever been is 48 hours behind. A

therapist 15 days behind can't possibly be documenting accurately. That then

becomes a liability for your entire clinic for a whole host of reasons.

In my mind, this would most certainly fall into the category of progressive

discipline. Probably serious enough to warrant a written warning with a

time-specific corrective action plan.

M. Ball, PT, DPT, PhD

Northeast Rehabilitation Gateway

Carolinas Rehabilitation

Orthopedic PT Residency Faculty

Charlotte/Concord, NC

On Jun 6, 2012, at 8:28 PM, " vallejos " <jose@...<mailto:jose%40hi5pt.com>>

wrote:

> Hello, I need advice with the following issue.

> I have one therapist who is always very far behind on his notes, so we can't

bill for them.

>

> Example it takes over 15 days to do the report for Initial Eval, but patient

is coming 3 times per week, this means we have initial eval plus 6 notes behind.

>

> Can you treat a patient without having a written plan of care?

> Which actions do you suggest?

>

> In advance thanks for any advice that help to solve this painful situation.

>

> Vallejos

> High Five Physical Therapy

>

>

[Guest guest]

I use a documentation program where the charges are entered on the same screen

as the treatment notes, and both need to be completed in order for the form to

be saved. Therapists are paid according to their charges. No notes = no saved

charges = no pay for the therapist. My therapists document very quickly as a

result.

Cohen PT, MS

MobileRehabNC.com

> >

> > Hello, I need advice with the following issue.

> > I have one therapist who is always very far behind on his notes, so we can't

bill for them.

> >

> > Example it takes over 15 days to do the report for Initial Eval, but

patient is coming 3 times per week, this means we have initial eval plus 6 notes

behind.

> >

> > Can you treat a patient without having a written plan of care?

> > Which actions do you suggest?

> >

> > In advance thanks for any advice that help to solve this painful situation.

> >

> > Vallejos

> > High Five Physical Therapy

> >

>

[Guest guest]

I use a documentation program where the charges are entered on the same screen

as the treatment notes, and both need to be completed in order for the form to

be saved. Therapists are paid according to their charges. No notes = no saved

charges = no pay for the therapist. My therapists document very quickly as a

result.

Cohen PT, MS

MobileRehabNC.com

> >

> > Hello, I need advice with the following issue.

> > I have one therapist who is always very far behind on his notes, so we can't

bill for them.

> >

> > Example it takes over 15 days to do the report for Initial Eval, but

patient is coming 3 times per week, this means we have initial eval plus 6 notes

behind.

> >

> > Can you treat a patient without having a written plan of care?

> > Which actions do you suggest?

> >

> > In advance thanks for any advice that help to solve this painful situation.

> >

> > Vallejos

> > High Five Physical Therapy

> >

>

[Guest guest]

Do your state PT licensure laws not discuss documentation in a timely fashion?

Oregon laws do, so maybe we are somewhat fortunate in that arena. Or maybe

there is something in your laws in regards to performing follow up treatment

without a plan of care. In addition, we have a departmental policy that

indicates within what timeline that documentation needs to be completed. This

probably doesn't help with your current employee, but maybe it could be of use

in the future. In a private clinic maybe you would instead have it be a part of

the job description or whatever standards/expectations you review when you do

performance reviews.

I agree- 15 days is an extraordinarily long amount of time - totally

unacceptable. I would also do a written warning with an action plan. Billing

aside - how can this be in any way accurate for the patient? I know that I

frequently have ideas at the moment that are important pieces to remember when

formulating my plan of care.

This therapist must never share patients with other PTs or PTAs, I assume?

~a

a Hranicka, OT/L

Clinical Program Leader

Occupational Therapy, HealthPlace Physical & Hand Therapy

Tuality Healthcare | 1200 NE 48th Ave, Suite 700, Hillsboro, OR 97124

- office | - fax