A study suggesting that “the role of the physician gatekeeper in regard to physical therapy may be unnecessary in many cases” could have significant implications for the US health care system, says the American Physical Therapy Association (APTA).
The study, published last fall in the journal Health Services Research (HSR), reviewed 62,707 episodes of physical therapy using non-Medicare claims data from a Midwest insurer over a 5-year period. Patients who visited a physical therapist directly for outpatient care (27%) had fewer visits and lower overall costs on average than those who were referred by a physician, while maintaining continuity of care within the overall medical system and showing no difference in health care use in the 60 days after the physical therapy episode.
The study is noteworthy because services delivered by physical therapists account for “a significant portion” of outpatient care costs in the United States, according to the study, and some health insurance plans require a physician referral for reimbursement of these services. In addition, although 46 states and the District of Columbia now allow some form of direct access to physical therapists for treatment/intervention, some of them nonetheless impose restrictions if patients have not been referred by a physician.
“Physical therapists have long known that direct access to our services is safe and effective,” said APTA President R. Scott Ward, PT, PhD. “The elimination of referral requirements and other restrictions has been a priority of APTA for decades. This study provides further evidence that direct access to physical therapists could go a long way toward helping to make health care more affordable and accessible for all. We encourage researchers and insurers to continue to further investigate this important issue that could have a profound impact on patient care.”
“When patients choose direct access to a physical therapist, it does not mean the end of collaboration with their physician, nor does it diminish continuity of care,” added Thomas DiAngelis, PT, DPT, president of APTA’s Private Practice Section. “We believe the results of this study will support our efforts to work with legislators and physician groups to establish policies that reduce unnecessary regulations, improve access, and build models of delivery that best serve the patient and the health care system. Although this study focused on direct access, it is not about the provider. It is about the patient. It means better opportunities to provide the proper care to those who need it, when they need it.”
Led by Jane Pendergast, PhD, professor of biostatistics and director of the Center for Public Health Studies at the University of Iowa, the study retrospectively analyzed 5 years (2003-2007) of private health insurance claims data from a Midwest insurer on beneficiaries aged 18-64 in Iowa and South Dakota. A total of nearly 63,000 outpatient physical therapy episodes of care were analyzed – more than 45,000 were classified as physician-referred and more than 17,000 were classified as “self-referred” to physical therapists. Physical therapy episodes began with the initial physical therapist evaluation and ended on the last date of services before 60 days of no further visits. Episodes were classified as physician-referred if the patient had a physician claim from a reasonable referral source in the 30 days before the start of physical therapy. Researchers found that self-referred patients had fewer physical therapy visits (86% of physician-referred) and lower allowable amounts ($0.87 for every $1.00 of physician-referred) during the episode of care, after adjusting for age, gender, diagnosis, illness severity, and calendar year. In addition, overall related health care use – or care related to the problem for which physical therapy was received, but not physical therapy treatment – was lower in the self-referred group after adjustment. Examples of this type of care might include physician services or diagnostic testing. Potential differences in functional status and outcomes of care were not addressed.
“Health care use did not increase in the self-referred group, nor was continuity of care hindered,” the researchers write. “The self-referred patients were still in contact with physicians during and after physical therapy. Concerns about patient safety, missed diagnoses, and continuity of care for individuals who self-refer may be overstated.”
According to Rick Gawenda, PT, president of APTA’s Section on Health Policy and Administration, the study should cause insurers and policymakers to rethink the physician gatekeeper concept when it comes to physical therapist services. “Evidence shows that, in the case of physical therapy, the physician gatekeeper model is doing exactly the opposite of what it was originally designed to do; it does not reduce ineffective and duplicate care nor reduce health care costs,” says Gawenda. “It’s time to end the physician referral requirement in every state, and it’s time for all payers to embrace direct access to physical therapists.”
Earlier research has supported direct access to physical therapists, but the new HSR study is the most comprehensive to date. A 1994 study analyzed 4 years of Blue Cross Blue Shield of Maryland claims data and found that total paid claims for physician referral episodes to physical therapists were 2.2 times higher than the paid claims for direct access episodes. In addition, physician referral episodes were 65% longer in duration than direct access episodes and generated 67% more physical therapy claims and 60% more office visits. The HSR study looked at a far more extensive number of episodes than the previous study, and also controlled for illness severity and other factors that could have affected the patients’ outcomes.
“In summary,” the researchers write, “our findings do not support the assertion that self-referral leads to overuse of care or discontinuity in care, based on a very large population of individuals in a common private health insurance plan with no requirement for PT [physical therapy] referral or prohibition on patient self-referral. We consistently found lower use in the self-referral group, after adjusting for key demographic variables, diagnosis group, and case mix. We also found that individuals in both groups were similarly engaged with the medical care system during their course of care and afterwards.”
The American Physical Therapy Association (APTA) represents more than 77,000 physical therapists, physical therapist assistants, and students of physical therapy nationwide. Learn more about conditions physical therapists can treat and find a physical therapist in your area at www.moveforwardpt.com.
The Practice Practice Section (PPS) is the business section of APTA that fosters the growth, economic viability, and business success of physical therapist-owned practices to benefit the public.
The Section on Health Policy and Administration (HPA) is a specialty component of APTA. The mission of the HPA Section is to transform the culture of physical therapy through initiatives that enhance professionalism, leadership, management, and advocacy to foster excellence in autonomous practice for the benefit of members and society.
Coauthors of the study were Stephanie A. Kliethermes, MS, a doctoral candidate in biostatistics at the Center for Public Health Studies, University of Iowa; Janet K. Freburger, PT, PhD, research associate and fellow at the Sheps Center for Health Services Research and a scientist at the Institute on Aging at the University of North Carolina, Chapel Hill; and Pamela A. Duffy, PT, PhD, OCS, CPC, assistant professor, Public Health Program, at Des Moines University.
The study was funded by a grant from APTA and its sections on Private Practice and Health Policy and Administration.
1. Pendergast J, Kliethermes SA, Freburger JK, Duffy PA. A comparison of health care use for physician-referred and self-referred episodes of outpatient physical therapy. Health Services Research. Published ahead of print September 23, 2011. DOI: 10.1111/j.1475-6773.2011.01324.x
National Physical Therapy Month (NPTM) is celebrated each October.
This is an opportunity for facilities to reach out to consumers and educate them about the unique benefits of treatment by a physical therapist:
- Significant improvement in mobility to perform daily activities
- Provision of alternatives to surgery
- Management or elimination of pain without medication and its side effects
This year’s celebration is focused on sports injury prevention across the lifespan.
For more information, go to http://www.apta.org/NPTM/
The Practice Department of the American Physical Therapy Association (APTA) has recently developed a resource called “Defensive Documentation for Patient/Client Management.” The tool was created in response to issues related to physical therapy documentation. APTA members can access the documentation here.
It’s time to start planning for October’s National Physical Therapy Month (NPTM). This year’s focus is on sports injury prevention across the lifespan. NPTM is an opportunity to reach out to consumers and educate them about the unique benefits of treatment by a physical therapist. For more information, go to http://www.apta.org/NPTM/
May is Exercise is Medicine® Month. This is a time when all providers are called to assess and review every patient’s physical activity program at every visit. It is a time for celebrating the health benefits of exercise and offering resources to get people moving.
“Everyone should start or renew an exercise program now as an investment in lifelong health,” said Robert E. Sallis, MD, FACSM, chair of Exercise is Medicine. “Every person, regardless of age or health, is responsible for his or her own physical activity. There are far more reasons to exercise than excuses not to.”
Exercise is Medicine partners include the American College of Nurse Practitioners, the American Academy of Physical Medicine and Rehabilitation, the American Medical Society for Sports Medicine, and organizations and universities from all parts of the world.
For the past four years, governors and mayors nationwide have signed on to proclaim May 2011 as Exercise is Medicine Month in their communities.
PTManagerBlog.com recently reported that a married couple, the owners and operators of Superior Physical Therapy in Sault Ste. Marie, MI, was sentenced to jail after being found guilty on charges of health care fraud.
Aaron Clark, the physical therapist at Superior Physical Therapy, admitted to felony health care fraud in a written plea agreement and will spend two years in federal prison with 3 years of supervised release. He has been ordered to pay $345,000 in restitution to Blue Cross Blue Shield of Michigan and Medicare.
Michelle Clark, the biller who admitted to a misdemeanor count of theft from a health care benefit program, will spend 90 days in prison with a year of supervised release. She will also pay $345,000 in restitution.
The two were sentenced in U.S. District Court in Grand Rapids, MI.
Chart Links offers physical therapy documentation software designed to match the workflow of a physical rehabilitation facility.
In addition to administrative and financial features like patient registration, referral management, insurance authorization, cross-discipline scheduling, charges, reporting/analytics, and outcomes, Chart Links offers the following physical therapy-specific features.
- PT Evaluations. Standard physical therapy documentation and evaluation forms library (i.e., cervical spine, shoulder, ankle). Contains numerous sections with the ability to customize into sets and forms.
- PT Flow Sheets. Electronic management of daily flow sheets (i.e., shoulder therex, exercise) with ability to analyze progress over time. Ability to link flow sheets to progress notes.
- Scheduling. Ability to schedule patient with PTA and PT in one easy-to-use feature.
- Patient Arrival Notification. Using our physical therapy documentation software, PT may receive a page on his/her beeper to be notified when a patient has checked in at the front desk.
- Wireless Access. Allows for un-tethered documentation (i.e., document in a wireless gym setting with hardware on a rolling cart, or, use a handheld wireless tablet PC).
- PT Patient Education. Print-on-demand patient handouts (i.e., home programs, exercises). Instructional and educational materials are available for customization and distribution. Ability to scan-in existing sheets or create-your-own. Ability to interface to third-party electronic formats.
- Authorizations. Monitor authorized visits for PT evaluation and follow-up visits.
- Compliance. Support of compliance efforts with JCAHO, CARF, HIPAA and other rehabilitation professional standards. Helps ensure compliance with Medicare CCI edits, modifiers and time tracking while documenting.
For more information, visit Chart Links at www.chartlinks.com
An article summarizing how Chart Links Rehabilitation Software streamlined the clinical and financial operations of an outpatient rehab practice recently got published in the Jan/Feb 2011 Rehab Management magazine. Read the full article below or link to it here.
by Andrea Marchi, PT, MBA, CSCS
EMR streamlines rehab practice’s clinical and financial operations.
Many therapists are considering the implementation of electronic medical record (EMR) solutions, but hesitate on making the purchase because they aren’t sure exactly how the technology will help their practice.
Our practice had the same concern initially, so we thoroughly evaluated the areas where an EMR could improve our business. It was quickly apparent that paper-based processes had a stranglehold on our practice. We suffered from many of the challenges other practices experience, such as: misplaced patient records; incomplete, untimely documentation impacting the billing process or regulatory compliance; productivity and financial performance data that was several months old by the time it was compiledWith the industry steadily moving toward widespread adoption of EMRs, we wanted to get ahead of the curve. Our facility, HealthPoint Rehab, which is affiliated with Southeast Hospital, handles about 33,600 patient visits annually out of two outpatient rehabilitation centers located in Cape Girardeau and Jackson, Mo.
There are numerous EMRs designed for physician practice specialties, but few that address the specific needs of rehab centers. We found a system designed to accommodate our team of 25 therapists engaged in physical, occupational, speech, and specialty therapies. Our system automates workflow for cross-discipline scheduling, referrals, insurance authorizations, clinical documentation, charges, and more. It includes Health Level 7 (HL7) interfaces to our hospital information system for effortless exchange of data. Most importantly, it supports our efforts to comply with professional standards while running an efficient business.
After a comprehensive system selection process, we implemented a software system in January 2009. The following information details how the technology has helped our organization over the past 2 years.
The biggest benefit we immediately noticed was the timely documentation of patient treatments. We have desktop computers installed within private exam rooms and laptop carts in our open gym spaces. Most of our therapists complete the treatment notes during the patient visit, while others finish after the visit.
In contrast, it took us much longer to get our initial evaluation paperwork to the physicians’ offices when we relied on dictation, transcription, and snail mail. We used to employ a full-time transcriptionist, but we have since eliminated the position and use the system’s faxing software to electronically fax our documentation to the physicians.
The structure of our daily notes within the software system has allowed our therapists to document procedures in a very clean and concise format. Another benefit is that our software system can ensure compliance with insurance regulations and therapy standards. During the documentation process, the system alerts therapists if they do not complete sections of the note that are necessary to comply with requirements from Medicare and The Joint Commission.
Using the EMR has helped us improve our billing process. Since charts are electronic and always available to the billing specialists when they need them, we complete our billing in a much more timely manner. We no longer waste time searching for the paper chart.
Unlike most EMRs, our rehab-specific solution has therapy-based billing capabilities built right into it. Correct coding initiative (CCI) edits built into the system help prevent errors that can result in returned claims or rejections from payors. The latest CCI edit table is automatically downloaded into the charge table, so we are always working from the most current version. Our system automatically reviews charges as they are being entered and alerts users if charges are improperly grouped or are missing modifiers. Using the system gives us the confidence that we are doing our billing correctly the first time, so we don’t have to worry about rebilling later in order to fix errors.
Further assisting our billing efforts is an interface that connects the system to the Meditech hospital information system at Southeast Missouri Hospital. The interface allows the systems to exchange information for billing and results, as well as admission, discharge, and transfer data. The result is a reduction in duplicate data entry.
The tracking capabilities of the EMR also help with compliance, especially when it comes to ensuring that physicians sign plans of care following initial patient evaluations. The system’s reporting capabilities enable therapists and front-office workers to easily view all plans of care that have not been signed by physicians, which helps accelerate follow-ups. And in cases where physician signatures have not been obtained, it tracks the number of times the plan of care was faxed by the system to a physician for signature. This tracking capability helps rehab clinics demonstrate their due diligence in trying to obtain signatures, which is Medicare compliant.
Prescriptions for therapy are also tracked. Upon receiving a physician’s prescription for therapy, it is entered into the system along with the number of visits that are prescribed or allowed by insurance. It also reports patients who have prescriptions that are about to expire, so the front-office can ensure we continue to treat patients with a current prescription.
A simple-to-use ad hoc analysis tool enables us to analyze practice trends, develop universal metrics, measure long-term changes, and gather operational decision-support data. Using the EMR’s analytics package, we have been able to analyze cancellation rates by patient type, determine our top referral sources by physician or physician group practice, track the number and type of CPT code charges, as well as proactively monitor staff productivity.
For example, by using the analytics module, we discovered that pediatric speech patients had the highest number of visit cancellations. Each cancellation negatively impacts our revenue and therapist productivity, so we developed new cancellation policies—applied to all patient types—to help curb the problem. By making patients aware of the new policy, we have been able to decrease our cancellation rate from 18% to 13%.
We also use the analytics module to track therapist productivity based on hours worked and units billed. In the past, we had one of our secretaries compile data to measure therapist productivity, but the process was cumbersome, and results were not available for 2 to 3 months after the time frame measured. Now, productivity is calculated weekly, so therapists can proactively monitor their productivity, which has been a wonderful management tool.
Another area we monitor with the analytics module is tracking referral sources. We can see exactly which physicians and physician clinics refer the most patients to us, which guides us in building relationships and growing our business.
The productivity of our front-office has been greatly improved by using the new system’s electronic scheduling capabilities. Now, scheduling is easy; as information can be clicked, dragged, copied, and pasted rather than entered manually. Also, scheduling multiple visits can be done all at once instead of creating individual appointments.
Front-office productivity is further enhanced by the system’s automated paging capabilities. Upon patient check-in, the system automatically sends an alphanumeric page to the corresponding therapist to let them know that the patient has arrived. Previously, the receptionist manually dialed the therapist’s numeric pager and during busy periods, it would be several minutes following the patient’s arrival before the secretary was able to send the page. In a business that bills based on time and units, a 3- to 5-minute delay can be the difference of billing an additional unit of service. In that regard, something as simple as automated paging may eventually lead to increases in revenue for us.
The EMR we selected has complemented our workflows and helped our practice improve productivity and documentation.
The most vital component to our successful EMR usage is that we selected a solution designed to operate in our business environment. The system’s rehab-specific capabilities allow our practice to automate the processes that matter most to our business. After using the solution for nearly 2 years, we can’t imagine doing our jobs without it.
Andrea Marchi, PT, MBA, CSCS, is the rehab manager at Southeast Missouri Hospital, HealthPoint Rehab, Cape Girardeau, Mo.
Effective management of any physical therapy, occupational therapy or speech therapy facility requires making informed clinical, financial and administrative decisions everyday.
At Chart Links, we provide an easy-to-use business intelligence and decision support solution that is capable of rendering complex information into a simple-to-understand format.
Visit our website to learn more about analyzing outpatient rehabilitation data.
Flow sheets are one form of documentation used by physical therapists in the daily notes for patient care. They provide a format for documenting exercises, repetitions and weights.
In Chart Links’ Rehabilitation Software, flow sheets provide electronic management of clinical data entry and review of patient progress over time. Flow sheets can accommodate multi-disciplinary documentation requirements and may be linked to progress notes and charges.
Visit the Chart Links website for more information about electronic physical therapy documentation.
According to the American Physical Therapy Association (APTA), October is National Physical Therapy Month and its focus is on our national obesity epidemic.
For the nearly 100 million Americans who are overweight or obese, physical activity must be a crucial component to weight loss and better health. According to a recent study conducted by the Trust for America’s Health, a research group that focuses on disease prevention, obesity rates continued their climb in 31 states last year. Health officials say the latest state rankings provide evidence that the nation has a public health crisis on its hands. Last year, The Centers for Disease Control and Prevention cited evidence that found that more than 22 percent of Americans did not engage in any physical activity in the previous month.
Physical therapists develop fitness plans for both adults and children that promote the ability to move, reduce pain, restore function, and prevent disability. For those who are overweight or obese, physical therapists balance the progression of the exercise prescription with the need for joint protection and safety during exercise.
Consumers can find information about National Physical Therapy Month, whose theme is “Physical Therapy: The Science of Healing. The Art of Caring,” by visiting APTA’s newly designed and easily navigable Web page for the month-long celebration at http://www.apta.org/nptm.
Physical therapists are health care professionals who diagnose and treat individuals of all ages, from newborns to the elderly, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan of care using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists also work with individuals to prevent the loss of mobility by developing fitness- and wellness-oriented programs for healthier and more active lifestyles.
The American Physical Therapy Association (http://www.apta.org) is a national organization representing 70,000 physical therapists, physical therapist assistants, and students nationwide. Its goal is to foster advancements in physical therapist education, practice, and research. Consumers can access “Find a PT” to find a physical therapist in their area, as well as physical therapy news and information at http:// www.apta.org/consumer.
Now available from the American Physical Therapy Association (APTA) for its members is the 2009 Physical Therapist Productivity Summary Report. The report provides actual data on the number of patients seen by PTs versus previous reports on productivity dealing with “expectations” of patients seen.
Watch the video published by the American Physical Therapy Association entitled “Move Forward: Physical Therapy Brings Motion To Life (APTA).”
The video supports the APTA’s new brand launch to depict the physical therapist as the provider of choice for helping patients restore motion and improve mobility in their lives.
“We will rebuild, we will recover, and the United States of America will emerge stronger than before.” These are the words of President Obama in his speech to the U.S. Congress last night where he called for comprehensive healthcare reform this year. The President talked about the cost of healthcare on families and businesses, indicating that reform work would begin as early as next week.
What kind of impact does Obama’s recently-passed Stimulus Bill have on physical therapists? PTProductsonline.com published this article titled “Stimulus Bill Includes Many Provisions for PTs.”
Executive Healthcare Management magazine recently spoke with John Barnes, CEO of the American Physical Therapy Association (APTA), about the effects of advances in technology and changes in health care needs on the physical therapy profession.
In the article, Mr. Barnes responds to questions like
- What have been some of the biggest developments in physical therapy practice over the last few years?
- What effect will the aging population have on the need for physical therapy?
- What challenges exist for entering the PT profession?
Chart Links was fortunate enough to advertise in this edition of Executive Healthcare Management magazine and encourages you to read the full article.
Chart Links has launched version 5 of its outpatient rehabilitation workflow management and clinical documentation product. The therapy software release includes features like flow sheet documentation, a fresh user interface, enhanced time tracking and patient appointment reminders.
“We’re proud to release technology that further enables medical rehabilitation practitioners to improve patient care, measure clinical outcomes and be more efficient,” says Ron Miller, M.D., President and Chief Medical Officer of Chart Links. “We’re committed to developing comprehensive solutions that meet the complex and cross-disciplinary workflows of outpatient rehab care.”
Chart Links Rehabilitation Software is used in charting patient progress for physical therapy, occupational therapy, speech-language pathology and audiology. It handles the entire outpatient rehabilitation workflow including scheduling, insurance authorization, referral management, treatment documentation, charges, outcomes, reporting and compliance.
Read our press release about Version 5 of Chart Links Rehabilitation Software.
Chart Links is advancing its product offering. With a new management team in place and a renewed focus on software enhancement, our interface will be fresh, our workflow management capabilities broader, and our rehabilitation-specific content deeper.
The new version will better meet the demands scheduling, documenting patient care, driving revenue and reporting outcomes for multi-disciplinary therapy care in an outpatient setting.
Features of the new therapy software will include:
- flow sheet documentation
- a new user interface
- enhanced Medicare Time Tracking features
- automated patient appointment reminders
Watch for a release in the coming month.
To gain greater efficiency and increased regulatory compliance, outpatient rehabilitation facilities across four campuses of California Pacific Medical Center, a Sutter Health Affiliate in San Francisco, have implemented Chart Links electronic documentation software.
“Our partnership with Chart Links helps fulfill the vision of allowing clinicians in our physical, occupational, hand and speech therapy programs to document electronically,” says Tami Chin, Director of Rehabilitation at California Pacific. “The software streamlines operations and electronically prompts our therapists — during patient documentation — to ensure greater compliance with Medicare CCI edits, modifiers and time tracking. These elements are essential to running an efficient and profitable department.”
Chart Links Rehabilitation Software automates the therapist’s documentation of daily progress notes including evaluations, plans of care, flow sheets, patient education, and charge capture. By automating this and other aspects of the patient management process, rehabilitation facilities realize greater efficiencies in the areas of turnaround time, physician approvals and therapist productivity. The software also helps to reduce overdue documentation and ensure greater compliance with regulatory requirements.
“Large multi-campus institutions like California Pacific cannot afford to remain paper-based,” says Ron Miller, M.D., Chart Links President and Chief Medical Officer. “Computerized scheduling, documentation, compliance and workflow management enable strong management teams — like the one at California Pacific — to improve operational and financial inefficiencies. In addition, our solution is driven by major accreditation and rehabilitation professional standards to help ensure regulatory compliance.”
To read about more customers, like California Pacific Medical Center, that use Chart Links Rehabilitation Software, visit the customer page of our website.