Happy Holidays from your friends at EIM
We appreciate all of your support. Enjoy!
MyPhysicalTherapySpace.com - A part of the 1T - the "One Thing" you need for PT practice.
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We appreciate all of your support. Enjoy!
‘Twas the day before Christmas
And all through the clinic
Physical therapists were trying
Not to be too cynic.
The charting was done;
The clinic was in order
As the therapists sat
And shared with great ardor.
At the top of their list
Was a special wish -
It could be surmised
To be a bit brattish.
They had a gift to give
All they needed was a voice –
A voice to proclaim
No never, never events
No drugs, no cutting,
Such a wonderful gift!
Why any headbutting?
Needing cost reduction,
we're a solution for payers.
Starbucks can’t be wrong,
Ignore the naysayers.
Needing access to care,
the older shouldn't wait.
There is no reason
To keep the physician gate.
Since it was Christmas,
filled with family, love and hope,
the therapists decided
they wouldn't take nope -
for 2009
they'd work together
to bring change
in the health care weather.
Merry Christmas!
Selena
I recently was informed that I am on the STATS Policy Workgroup nominated by several colleagues including several loyal readers of this blog. STATS is the Short Term Alternatives for Therapy Services (STATS) contract by the Centers for Medicare and Medicaid Services (CMS) to perform follow-on claims analysis and to work with outpatient therapy stakeholders to develop recommendations for improving outpatient therapy payment policy in the short-term. There are 2 workgroups-Policy and Clinical. There are several PT’s, OT’s, and SLP in the workgroups.
The mission of the STATS Policy Workgroup is as follows:
– Evaluate existing payment policy (not limited to existing outpatient therapy policy).
– Identify specific policy applications that could reduce barriers to the efficient/effective delivery of medically necessary services.
– Identify specific policy applications to increase confidence that medically necessary services are being delivered.
The project is roughly 2 years and is very committed to not only productive dialogue but transparency as well. I have received permission to publish this and to seek suggestions and recommendations directly by you and I assure you that these suggestions once consolidated will be forwarded as appropriate.
Per the director of the STATS workgroup:
A chief constraint of our activities will be to discuss policy options that are realistically achievable in the short-term. For example, some changes in Medicare Manual language and some coding changes, if appropriate, can be achieved in relative short periods, while complex changes to CMS payment systems or forms may take extended periods of time. We are not seeking to develop a new instrument or to validate an existing tool as other CMS contracts serve those longer-term analyses. However, among several options, we are considering if it is feasible that existing processes being used by clinicians could be used in a new short-term policy to help describe clinical need and/or progress on the claim form through the introduction of new codes that could serve to describe clinical information (e.g. severity, progress, or outcome). The proposed introduction of such information may have policy implications within the scope of CMS activities (e.g. Medicare Manual language and regulations) to those beyond the direct scope of CMS control (e.g. Social Security Act or CPT-4 and ICD-9 coding development). This workgroup will help inform CSC of policy variables to consider, as well as policy barriers that need to be addressed in order for proposed options to be considered viable.
Time constraints may be the largest barriers to some potentially good suggestions. As the project proceeds, it will begin to focus in on the most realistic options and begin to address the details of what would need to be addressed for those option(s) to be realized.
Here is your assignment! Prior to Jan 4, please comment directly on this blog or to me at larry@physicaltherapist.com the following:
What are the top 5 most achievable short term policy options that help better identify patient need for therapy and/or measure progress/outcome?
Your feedback and input is greatly appreciated.
Happy Holidays from your friends at EIM.
larry@physicaltherapist.com
No, this isn’t any holiday version of Bizz buzz, but 3 significant figures out of 2 very well written and must read articles from Mckinsey Quarterly entitled Why Americans Pay More for Health Care and Three Imperatives for Improving US Health Care.
650 Billion represents how much more the US spends on health care than might be expected given the country’s wealth and experience of comparable members of the Organisation for Economic Co-operation and Development (OECD).
65 represents the percentage of care which has now shifted to outpatient environment. Although this is a much cheaper venue than hospital in-patient, it has not resulted in any spending savings at all and as the article aptly points out is due to significant fee for service environment causing hi utilization, hi cost (e.g MRI) and hi profitability where physician’s and surgeons can direct patients (like surgical centers). Specialists particularly are implicated in this article. This outpatient “shift” is responsible for approx 2/3 of the 650 Billion excess that US health care spends.
15 represents the percentage amount of total spending that consumers provide to the health care spending “pie”. Despite some emphasis in “consumerism” such low percent continues to shield patients in the big picture of health care.
By the way, in the Three Imperatives article, EBP is given some lip service.
Projected Federal Spending Under One Fiscal Scenario
Because health care is so large, instead of doing an analysis of the entire Federal budget, CBO decided to just do an analysis of healthcare. This chart essentially represents as best as I can tell from this CBO report, a “compilation” of sorts of the 115 scenarios involving changes to the federal health problems.
However (and I think this is very relative), this chart and analysis was done prior to the bank bailout and the auto bailout which in aggregate represent about one year’s worth of health care (slightly under 1 trillion for the current bailouts which approximates what we spend on health care in one year).
Amongst the options, cuts in payments to providers, end to fee for service, utilization of a “medical home” concept where the primary care doc can be more efficient with referrals (not a joke), and adjustments to the SGR, oh-and lots of way to expand the CMS program are also included (only the government health care system thinks they can expand benefits while decreasing costs).
An “EBP approach” is mentioned which would cost $860 million to research and then would save 1.3 billion. Higher pre-cert requirements for imaging, according to their estimates, would save 1.1 Billion.
There appears to be huge savings in health information technology-to the tune of $22.8 Billion. This nebulous category and savings “guess” is lost on me in comparison to what the pale savings by other measures mentioned (including their EBP guess). The savings cited include reduction in administrative costs, reduced number of inappropriate tests and procedures, and reduced paperwork. There are incentives for physicians to participate and penalties for non-participation. (note for file: have never seen reduction in paperwork with more automation).
In addition, there is no “analysis” of legal reform or referral for profit measures in this 235 page document which would be “low hanging fruit” for savings in my opinion. All in all, mostly old ideas repackaged and they never seem to understand that incremental savings out of providers pockets reduces access to services as more providers just simply limit the number of medicare patients in their practice.
First we had our good friend Mr. Mai in Mass. Now we have several cases in Mississippi including Dr. Thomas allegedly and incorrectly billing PT services to CMS in the neighborhood of $16 Million. Per the OIG release:
“…the so-called physical therapy services were provided in patients’ homes by unqualified, inadequately trained, unlicensed technicians with no supervision and then billed as though Dr. Thomas had provided or supervised the services”
A couple of observations:
1. Isn’t “unqualified, inadequately trained, unlicensed technicians with no supervision” wordy, redundant, and verbose!? Doesn’t it to a certain extent display how uninformed CMS is regarding technicians since they are all by definition for in home services unqualified? Can you have an adequately trained, unlicensed technician, with no supervision in a person’s home? At least not according to the rules.
2. Of note, is that these cases are out and out fraud. Many within our own profession are trying to scare PT’s with the “F” word by their own self-rightous interpretation on various rules that CMS has as well as CPT codes which are often in conflict or superimposed on state regs. These case are none of that-they are clear and conscious attempts to rip off the government by crooks.
thoughts?
Pain and expectations go together.
While in a mall outside of Philadelphia this last weekend, I dissected "The Power to Heal."
First, this banner suggests that back pain is disabling and non-relenting. Thank you SOO much for that contribution to fear and anxiety, Abington Memorial Hospital.
Second, seeing a surgeon will be the solution. Uh, huh... thanks for creating an expectation that those in back pain just have to see a surgeon. Sure, let's keep the cost of care soaring.
Third, surgery provides quick results. Evidence doesn't suggest this, but kudos for planting that seed to enhance the placebo aspect of surgery.
This wasn't the only banner suggesting surgeons or surgery as an option for various conditions.
The shoppers at Plymouth Meeting Mall need to have other options and more realistic expectations.
Can 2009 introduce a different expectation... the Best First Choice?
Photo by Selena
Selena
And the winners of EIM’s 30
Second Elevator Pitch Competition to answer “Why physical therapy is the best
first choice in musculoskeletal care” are….
1.
BJ Lehecka
from Wichita State University won the top prize of $1000!
http://www.youtube.com/watch?v=CH4ywhBbp5Q&feature=channel
2.
Joe Palmer SPT
University won second place prize of $500!
http://www.youtube.com/watch?v=-Rqa_KU6I2U&feature=channel
3.
Kim Parsons from
Ohio State University won the third prize of $250!
http://www.youtube.com/watch?v=Bop7gEtfl1A&feature=channel_page
Congratulations to those that won!!
You will be contacted soon so you can collect your prizes. Thank you to
everyone who participated…it was a great competition!
I wonder how Mr. Mai convinced the PT’s and PTA’s to prepare the “made up” evaluations and notes.
Haven’t heard of this kind of fraud since a PT out west was thrown in jail for billing dead people.
