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The Results of One Court Case Will Affect the Nation

Is an orthopaedic surgeon a "qualified health care provider" with regard to providing physical therapy services?

According to the Kentucky Supreme Court, yes, an orthopaedic surgeon can provide physical therapy services and is a qualified health care provider. What can I say? Over the last 6 years, the case went through the whole darn court system and a final ruling occurred in the Kentucky Supreme Court. The result... since section (1) proviso allows orthopaedic surgeons the authorization to provide physical therapy services, but since section (3) disallows the orthopaedic surgeon from referring to the services as physical therapy either directly or indirectly - an "absurd" situation is created. Apparently, the General Assembly wanted the statute to be considered as a whole and for all pieces within the statute to be relevant. The General Assembly would not want an absurd statute.  It all comes down to it being absurd that an orthopaedic surgeon can't offer and bill for physical therapy services provided by an athletic trainer using CPT 97001 and 97002.

Personally, I find it not only absurd but also illogical that an orthopaedic surgeon would be allowed to provide physical therapy services without a physical therapist providing services.

If we put some practicality into the situation... first of all, an orthopaedic surgeon is not in the clinic every day of the week.  The "surgeon" will have 1 or 2 days (or more) per week in an operating room, right?  So, when the surgeon is operating, the surgeon really can't be supervising any physical therapy services that might be concurrently provided within the surgeon's clinic right?  We'll forget about that reality for a minute.  When the surgeon IS in the clinic, what is the surgeon doing?  If we guesstimate the surgeon has an 8 hour working day, then that means the surgeon has basically 480 minutes.  Of that 480 minutes, the surgeon will probably have 20% downtime - waiting for radiographs or MRI results or conversing with other colleagues or documenting... that leaves 364 patient contact minutes.  Approximating an average of 10 minutes of surgeon-to-patient contact, a full day would be approximately 36.4 patients.  In that full day of surgeon-to-patient contact, does it seem reasonable that a surgeon would have the time to adequately address and supervise the provision of physical therapy services being provided by an athletic trainer?

Until third party payers eliminate referral for profit situations, the Kentucky Supreme Court opinion just may create ripples across the nation substantiating the legal right for physicians to provide physical therapy services.  Until consumers care enough to compare before they seek a physical therapist for their condition, the situation won't change.

Is it possible for physical therapists to create a viral message?  Physical therapy isn't physical therapy without a physical therapist. Put the PT in physical therapy. 

What are your thoughts?

~Selena

2010 International Private Practice Business Summit!!

Larry Benz at the 2010 International Private Practice Business Summit

 

Hello!

I would like to personally invite you to the 2010 International Private Practice Business Summit on January 22-24, 2010.  The Summit is a 3-day business meeting for private physical therapy practice owners. There will be more than a dozen experts presenting on topics related to the business of physical therapy and strategies for creating high performing and prosperous world-class clinics.  This Summit will motivate, inspire and teach everything you need to know to transform your clinic into a top-notch, competitive, enjoyable business. 

 

I will be presenting “Clinical Excellence Begins with World Class Customer Service”  on January 22^nd.  While physical therapy clinics are stressing their clinical expertise, practices with unprecedented focus on the customer experience and service excellence are gaining market share, “buzz”, and loyal repeat patients trumpeting their competition.  I will focus on the ultimate outcome of a physical therapy experience-an emotionally engaged, enthusiastic ambassador who has been impacted for life from treatment at your physical therapy clinic.   This session will give you the tools to deliver and sustain “the best” customer service experience for your patients.

 

Registration opens today, October 28.  If you register prior to November 19 you will receive an early decision maker discount.  Click here to register.  

 

Hope to see you there!

Larry

Medical Necessity... To Fix A Problem There Cannot Be Two Standards

Health Care Reform... 21.5% reduction in payments to providers... possible shifting of reimbursement to favor primary care physicians... possible reducing payments to physical therapists to increase payments to cardiologists and oncologists. 

It seems to me to really resolve any problem there are always various considerations.  In the case of health care reform... there are at least 3 entities to consider.  1)  Medicare - its processes:  the inefficiencies, strengths and weaknesses  2)  Providers -  their processes:  how clinical decisions are made, the risk/benefit of the decisions and 3) Patients - their behaviors:  when they seek services, their responsibility in taking care of themselves, when they make poor choices.

I am so ready for a primal scream when I see something like the above and then read the details.  The government can't have it both ways... their audits in clinics capturing money paid inappropriately due to lack of "medical necessity" basically based on review of records yet the allowance of $60 billion in fraud to people who easily scam Medicare!  Medicare is paying for that fraud annually (of course, these are just the ones who got caught)!  In all honesty, providers should not take such a hit in reimbursement yet.  Medicare should have its own work cut out to clean house and ensure someone really needs an electric wheelchair or an electric prosthesis.  Amazing to hear Medicare will easily pay for 2 lower extremity prostheses and an electric upper extremity prosthesis on the SAME person!  Now come on, how many people 65 and older do you know who are THAT bionic?? 

I have no clue how powered mobility devices are billed.  I do know if a patient received any kind of prosthesis concurrently there would be claims sent for physical therapy and maybe occupational therapy.  I would think a darn computer system could process durable medical equipment claims for defined durable medical equipment items 20-30 days after receiving the claim and only pay if inpatient services or outpatient physical therapy services were provided within the same time frame.  I'd highly doubt anyone receiving a prosthesis would know how to function and be safe without some level of education and training.  Even if the prosthesis was a replacement, Medicare can just make a rule that rehabilitation services are required. 

If 10-12% of claims are for physical therapy services, does it seem strange to anyone else that OIG will be focusing on outpatient physical therapy services provided by independent physical therapists?  I highly doubt that physical therapists in independent practice are exploiting the Medicare system intentionally or unintentionally at the magnitude the guy in the video was.

~Selena

Managing cost vs care-the flaw in "bundling"

In yet another shotgun approach to saving healthcare, USA Today ran a front page article “Can ‘bundled’ payments help slash health costs”.

It detailed a 3 year medicare demonstration project in Tulsa, Ok which started this past May whereby CMS will pay a single payment for all the hospital and doctor care for heart and joint procedures rather than the traditional separate fees for providers and facilities.  A picture of a patient receiving PT at one of the “approved” PT centers participating in the “bundling” program is shown.  The article points out pluses and minuses of this concept.

While no doubt a bundled system for certain items in medical care makes great sense and we have frequently documented in this blog the problem of “overtreatment” and the article aptly points out the collective efforts to eliminate waste in the surgical process (e.g. too many surgical drapes) as well as care that is not based on good evidence. However, the notion of transferring administration of care and payments to a hospital makes about as much sense as having the vehicle license bureau co-exist as a dayspa. 

It is one thing for a hospital system to be forced with DRG’s and other bundled payments by a payor but that is significantly different than putting the hospital in a system to negotiate with implant companies, contract with the most efficient providers, and then transact claims and payments to providers.  Managing cost and managing care are as different as selling license plates and performing a facial.  At the end of the day, you would end up with a significant conflict of interest-all services would be rendered at a hospital which is the most costly cog in the system or there would be the “limbo” contracting of providers and services for rates probably half of what medicare currently reimburses.  The article aptly points this out to a certain extent by mentioning the hi cost for the hospital to purchase a claims system and to invest in advertising and promotion.  For those keeping track, it is a Physician Hospital Organization (PHO) of a slightly different color and we all know how successful and sustainable those were in curbing healthcare costs in the 90’s.

As a provider, I can think of several times when a common sense thing like “bundled” payment (or per visit) was tried in physical therapy only to suffer from the “system” problem-payor IT systems can’t handle and the administrative nightmares forced abandoning the “good idea”.  While systems improve and change and I am aware of many per diem contracts (most of them pay lousy in my experience), this is altogether different than a procedure that involves many providers and coordinating of services. 

As we have pointed out on this blog several times, there is no quick fix or innovation of healthcare.  When you hear of the “one great idea” look well beneath the hood.  A complex system like healthcare cannot be fixed by simple solutions.

Thoughts?

larry@physicaltherapist.com

 

A Boy Implements Evidence into Practice

Initial thoughts on active video games, such as the Wii, included, "hey, it's better than nothing."

Is it though? 

An 11-year old (Deniz Ince) noticed more pain in his finger joints and wondered if the pain was related to playing video games.  Ince's dad, a rheumatologist, must have introduced him to Yusuf Yazici, MD to assist in answering if playing video games contributed to finger joint pain in kids.

The 11-year old was listed as the lead investigator of the submitted abstract which was accepted at the American College of Rheumatology/Association of Rheumatology Health Professionals 2009 Annual Scientific Meeting.

Of the various game consoles and handheld units, the Wii was the only device associated with pain for all 7-12 year old kids regardless of how many hours it was played.

I loved Deniz Ince's thoughts on the Wii after his study was presented.  Based on the study findings, he is no longer playing video games as much as he was.

If an 11-year old boy can change his behaviors based on evidence, why do adults have so much difficulty?

photo by Ian Muttoo via Flickr

~Selena

AAOMPT sSIG Grass Roots Letter Writing Campaign 2009

American Academy of Orthopaedic Manual Physical Therapists

Student Special Interest Group (sSIG)

Grass Roots Letter Writing Campaign 2009

The AAOMPT-sSIG Grass Roots Letter Writing Campaign is an effort to support Capitol Hill Day 2009, an event that was co-sponsored by AAOMPT and the Orthopaedic Section of the APTA. On October 15 over 150 physical therapists and physical therapy students descended upon Washington, DC to bring the physical therapy musculoskeletal message to members of congress.

We envision and urge students, clinicians, researchers, professors, and others who are passionate about the profession of physical therapy to blast the hill with letters of support and important information regarding physical therapy, physical therapy practice, and current issues such as health care reform. YOUR letters, e-mails, and phone calls will reinforce the personal meetings and messages of Capitol Hill day participants!

If you are reading this we urge to PLEASE pass this information on and encourage those that you can to participate in advocating for our profession. 

All of the information on how to find and contact your representatives is available as a BLOG POST on the AAOMPT-sSIG Blog. Please leave a comment on the previously mentioned blog post with the number of correspondences sent and your state of residence. Further, this information it is contained in the attached documents. It is EASY and only takes a few minutes. 

!!!CLICK HERE!!!

We graciously thank YOU for the support of this cause and the profession of physical therapy. Further, please visit the AAOMPT-sSIG Blog. Read the posts and leave comments, critiques, and suggestions. We want YOUR input. Please contact us if you have any questions at: sSIGAAOMPT@gmail.com

Individually, we can all make a small contribution whether an e-mail, a letter, or a phone call. Collectively, these individual contributions can make a REAL difference. These letters will support and reinforce the efforts of those able to participate in Capitol Hill Day. October is National Physical Therapy Month. Let us all contribute to this cause and let our voices be heard regarding the future of our beloved profession. Every letter, e-mail, and phone call helps!

The AAOMPT sSIG Team

National Student Conclave

Greetings!

I am Rob Wainner and wanted to touch base with you to let you know that I will be attending the National Student Conclave next week in sunny Miami. Please stop by EIM’s booth, #708, to learn more about our Residency Program. It’s the largest and fast growing in the US! I would love to meet you personally and let you know more about our program. At the same time, you can also learn about our many other educational opportunities: Fellowship, Executive Program, OCS Exam Prep Course, Emergency Response Course, and CE programming. Want to win a thousand dollars?! Make sure you ask about EIM’s Elevator Pitch Competition where we will be awarding $1000 to the top entry.

I will be there along with George Burkley and Jessie Dugan; between the three of us I am sure we can answer any questions you might have.

We are also giving away “FREE STUFF”: an hour of free career advice from me, a copy of The Users’ Guide to Musculoskeletal Examinations, or a $25 American Express gift card. It’s a win-win situation…you can learn more about EIM while entering to win prizes! However, you have to drop by the booth to enter and win.

See you there!

Rob Wainner

Reducing Ineffective Back Surgeries

Interesting interview in the Colorado Public radio with Dr. Chris Stanley, Senior Medical Director for United Healthcare of Colorado.  Apparently,there is a Colorado Low Back Collaborative which hopes to prove that doctors, hospitals, and insurers can improve quality and reduce cost if they work together.

Hip Hip Hooray!

One problem conveniently not mentioned.  This is a little tough to do with United paying below market rates to PT’s-often in the $50 range!  The only providers crazy enough to accept such rates are contributors to the low back problem and not part of the “collaborative” solution.

Thoughts?

larry@physicaltherapist.com

Meet Molly, the Pony with a Prosthesis

     

Every day physical therapists work with people who have some level of disability.  These people always have some degree of work cut out for them to reach their maximal potential. 

Wouldn't it be great to have the power of a "Molly" readily available?  I'm not talking horse power.  I'm talking about the power of the connection people have with animals - animals they don't even know.  It always amazes me how easily people perceive animals as smart, determined, friendly, understanding, or special.  Molly has been traveling and inspiring soldiers with amputations, kids with cancer, and normal healthy kids.  Do you need to somehow connect with kids and have no Molly? You can order the story: Molly the Pony - a True Story.

How do you motivate your patients who don't seem enthused about putting forth the effort to reap the benefits of physical therapy?

photo by muskokarocks via photobucket

~Selena

Smokey's 2009 AAOMPT Annual Meeting wrap-up

Although I am an indoor cat and it is always exciting to take a road trip, there is no place like home. I have arrived home safe and sound after another wonderful AAOMPT meeting, and I am almost done unpacking my bags.  

(Aside from trips to the vet and important meetings like AAOMPT, evidence-based cats should stay home. Did you know that the risk of illness, injury, and death to outdoor cats is almost as bad as the risk of illness, injury, and death to human spine surgery patients?)

For some great information on how to stay cyber-savvy from home or office, see Eric Robertson’s  interesting breakout session presentation entitled PT 2.0 Considerations for an Evolving Marketplace. 

Many thanks to all the dedicated and hardworking AAOMPT officers and committee members, the excellent speakers and presenters, the exhibitors, and our new friends at DMG for providing another outstanding conference.

Mark your calendars now for the 2010 AAOMPT Annual Meeting in San Antonio, TX, October 6 through 10!

In the meantime, see you in cyberspace!

Cheers from Smokey the EBC