Content Matters

Your practice website can do wonders for your business—if it conveys the right message.

By Chris Hayhurst, MS

When visiting a well-developed website, you can put yourself in a hypothetical, prospective-client’s shoes, finding everything you need to: a) determine whether this clinic is the right one for you; b) decide whether its professionals are sufficiently qualified; and c) learn about the evidence supporting their work. The content is concise, informative, and patient-centric.

For example, when you visit the website for Body Dynamics, Inc., a physical therapy and wellness practice in Fall Church, Virginia, and hit “location”, you are greeted with a quote: “Wherever you are in your journey, we’ve got a space that meets your needs.” The site explains that the clinic is physically divided into zones. Coming in for a group “bootcamp” fitness session? You’ll be working out in the “red zone.” Recovering from an injury and need one-on-one physical therapy? For that you will go to the private “green zone.” Everything is on the site—from directions to testimonials to a comprehensive list of services. Founder, president and director of clinical services, Jennifer Gamboa, PT, DPT, OCS, MTS, says the key reason her website works is that it feels authentic. She explains the clear and recurring message is that “we’re all in this together, we care, and that we are here to build relationships.”

A Near Miss

It may help to state the obvious: No practice can depend solely upon the marketing power of its website to build its client base. Yet, a well-designed site featuring valuable content tailored to the needs of your prospective clients can do wonders for business—and creating that site does not have to be difficult.

Gamboa says she and her staff create and update the content for their site themselves. They hired a designer to build the site, and a copyeditor to double-check their work, but the writing, the photos, and the forms all come from within the practice.

In 2012, as the clinic prepared for an impending relocation, Gamboa and her colleagues decided it was time to overhaul their site. They had built it themselves years earlier and saw the move as the perfect opportunity for an upgrade. “People were going with these website-design companies that did all the work for you. It was tempting, she recalls, but then she thought again. The template style felt too robotic, too automated for her. That personal connection was the foundation of Gamboa’s business, and she decided to re-launch the website in-house.

A Work in Progress

To ensure that the content they developed was on target, they held a series of focus groups, which included clients. “We invited our patients to help us. Some were specific invitees—long-term clients whom we knew would give us a good perspective and some were more arbitrary. We were trying to overcome our own tendency to think we knew our message,” Gamboa explains. “We wanted to tell our story, to define who we were in a way that everyone could understand— and it had to be meaningful.”

Those focus groups proved invaluable for the team. “Our clients told us, ‘This is what you do, this is what you mean to me, this is why I am coming here versus anyplace else, and that is the message you need to get across.’” The Body Dynamics vision statement grew out of this lesson, she adds. “We meet people where they are, without judgment, and we take them where they need to go, in a place that feels safe.” Now, says Gamboa, every piece of content that appears on their website attempts to convey that message in some way. It takes work, she says. “Writing, photography, working with the designer, feeding the content to their copyeditor and having “three sets of eyes look at everything before it is posted.” It is worth it. “I truly believe you have to distinguish yourself from everybody else. You have to tell your story.” If you don’t, she says, your prospective clients “will have no reason to choose your practice” over the competition. And that, of course, will be it: click, click, gone.

Content Ideas

Looking for ways to convey your story?
Try:

  • Staff profiles in question-and-answer format
  • Success stories, featuring real patients (either anonymously or with their permission)
  • Interviews with other health care providers, health experts, and researchers
  • Blogging (what is new at your practice and comments on the latest evidence.)
  • Email newsletters (similar to a blog, but delivered straight to your clients’ inboxes)

 

Hayhurst

Chris Hayhurst, MS, a regular contributor to APTA’s PT in Motion, creates and edits custom content for healthcare professionals, businesses, and organizations. Find him online at www.healthwellwriting.com, or via email: hayhurst33@gmail.com.

Surviving an Audit

How an Electronic Medical Record system can help you dot your i’s and cross your t’s when it comes to therapy documentation.

By Karen Christen, PT, and David McMullan, PT

Therapy documentation is extremely complex. Therefore, it should come as no surprise how difficult it is for a clinic to achieve 100 percent Medicare compliance. Physical therapists must know a great number of concepts and complete numerous forms while simultaneously treat patients. The two biggest auditing challenges associated with therapy documentation are capturing the required information and supporting what a therapist bills patients and third-party payors with clinical documentation, including Medicare as well as other third-party payors. From a Medicare perspective, these are the two most scrutinized areas of documentation and where the highest level of audit failures occur.

When documentation does not support the charges a clinic generates or support how much time is spent with a patient, whether intentional or not, it is considered false billing or fraud by Medicare. From Medicare’s perspective, insufficient billing raises a red flag, which, in turn, can change what would have been a simple audit into a much more expansive audit, including a broader range of patients over a longer period. The result is potentially higher penalties. For clinics that rely on paper documentation versus an electronic medical record (EMR) system (also referred to as an electronic health record system or EHR), the task of ensuring sufficient documentation is that much more difficult.

The Pitfalls of Paper

In a paper world, policies and plans are put in place to ensure all the correct boxes are checked and necessary details are included. This usually involves the development of templates, which list a variety of required components. Clinical staff and therapists are trained to ensure required sections are never missed. Yet, no matter how much due diligence is done, the risk that someone will forget or are unaware when a form is required for a specific patient/payor combination. In a paper world, no prompts help clinicians along the way nor blocks prohibit them from moving on to the next question or page when previous areas are left blank.

Medicare guidelines also require therapists to prove, through detailed documentation, the total amount of time a patient was seen and the total amount of treatment time. The total amount of one-on-one time with each patient dictates how many time-based codes can be billed. The goal is to ensure that the total treatment time is at minimum equal to—and preferably more than—the total one-on-one time. In a paper world, these are challenging to manage and maintain, often calling for time-consuming manual cross-referencing. However, a good EMR will automatically capture this information. Treatment detail is documented within the system, including how much time a therapist spends with a patient. With just a few taps on a tablet or clicks on the keyboard, therapists can dictate whether it is a one-on-one service or not. The EMR system will also alert therapists if one-on-one time is higher than the total treatment time. The EMR system captures all documentation details and allows staff to review the document for inaccuracies, which can be corrected when identified.

Another documentation challenge is Medicare’s required Plan of Care, which is essentially a therapist’s authorization to treat a patient. The Plan of Care is comprised of specific timelines and guidelines that must be completed either prior-to or during a patient’s initial visit. Plans must be sent to the referring physician for review, certified, signed, and sent back to the facility in a timely fashion for a patient’s treatment to be authorized. Creating a Plan of Care in a paper environment is another time-consuming, labor-intensive process that requires a lot of follow-up to ensure all authorizations are received within the required timeline. A good EMR system will significantly speed things along and ensure all required authorizations are received.

When a Plan of Care is generated through an EMR system, tracking mechanisms document when it was created, when it went to the physician, when it was signed, and when it was returned to the clinic. System prompts will alert staff to delays and track progress along the way to ensure the appropriate authorization to treat is received and all visits and services are covered appropriately from an authorization perspective.

For a paper-based facility, achieving Medicare compliance is significantly more difficult. Deploying a therapy-focused EMR system can help clinics achieve compliance and simplify processes, which will save time and money.

FHN’s Audit Success

The number one reason Freeport Health Network (FHN) moved from paper to an EMR system was the goal of becoming compliant—secondary reasons included time savings, better charge capture, legibility, and ease of getting documentation to physicians. Just two months after deploying an EMR system, the decision was justified—FHN was audited and easily passed.

Prior to deploying the system, FHN relied entirely on paper documentation and compliance with Medicare documentation regulations was below par. Trying to keep physical therapy, occupational therapy, and speech therapy in mind while treating patients proved to be too much. For example, Medicare requires lots of repetition, goals written out on an intermittent basis, and treatment details. Medicare also requires a discharge summary, which isn’t always done during a visit. It is not uncommon for a patient to call and say they feel great; therefore, they aren’t coming back. Even when a patient doesn’t come in for a final visit, Medicare still requires detailed documentation regarding what was said during the call. These summaries require a re-write of everything, from when the patient first came to the therapist, what the therapist saw, what was said, what was done, what happened along the way, and where the patient is today. FHN also was moving in the direction of becoming Joint Commission accredited, which is more stringent than Medicare, elevating the need for clinicians to “get documentation right.”

Aware the difficulties of achieving compliance via paper documentation, a task force was put in place at FHN to educate staff on what compliant documentation requires. The team looked at a number of EMR systems. While they found certain aspects of some products appealing, some were prettier while others were seemingly faster, the main priority was a system that ensured the smallest details were not missed.

Since deploying an EMR system, daily notes take significantly less time, discharges are a breeze, there is less running around the clinic transitioning between patients, and scheduling is much easier. Chart reviews are stress-free, as well, while discharges take literally seconds because documentation is created along the way with each and every visit. Clinicians simply open the note and sign it. This was huge for staff, some who easily had 30 charts that needed to be discharged. Prior to deploying an EMR system, discharges were often backlogged because they were tedious when done on paper.

Easing Audit Pains with EMRs

Previously, a Medicare audit required clinical staff to randomly pull 10, 15, or 20 charts. The auditor would thumb through the documents ensuring compliance was met. Illegibility and missed information were not uncommon. As mandates become increasingly more complex and electronic documentation more common, passing an audit in a paper world is a difficult task. The legibility of an EMR automatically improves audits because it is easier to read and find information. Documentation is typically more thorough because of the logic built into EMR system, which helps prevent missing data. However, it is important to note, not all EMR systems are created equal.

Too often, clinicians get so caught up in a system’s ease-of-use that they forget about compliance. There must be a balance between ease-of-use and functionality. Clinical staff members want a system that is easy and efficient, but the system should not be so easy that it is not compliant, nor should it be too burdensome or rigid. For example, a system that is compliant for Medicare should not force all of the same Medicare rules onto every single payor. This act can overburden documentation requirements and efficiency because it has only one rule set that has to be applied to everybody. At the same time, the system should not be so flexible that the clinicians themselves have the ability to miss compliance requirements, just to finish their notes quickly.

Therapists have an obligation to provide the best care for their patients. They must also ensure— and prove—billing practices are appropriate with the service provided through clear, concise documentation. A good EMR system can help therapists achieve both.

Karen Christen, PT, is director of rehabilitation, occupational health, and pain services for FHN.

David McMullan, PT, is a PPS member and vice president of product management in the therapy division of SourceMedical. He can be reached at david.mcmullan@sourcemed.net.

Perspectives

Margot Miller
By Margot Miller, PT

I HAVE HAD THE PRIVILEGE OF BEING A MEMBER OF THE IMPACT EDITORIAL Board for more than 10 years. I became involved with Impact even before we had a formal editorial board—then I became a board member and moved to my current role of assis- tant managing editor a couple of years ago. Through Impact and PPS I have met more members and developed more relationships than I ever would have by simply being a member! Since this is my last year on the board, I wanted to share some perspectives that I believe define Impact and PPS.

Just Ask. As is true in many organizations, Impact counts on volunteers. It is the respon- sibility of Impact board members to find authors who are willing to contribute articles. This task requires asking, following up with authors to make sure articles are on track, as well as performing an initial edit. What surprises me is how easily we find authors! People are genuinely pleased to contribute. We have a wide range of topics that interest authors as well as other PPS members. Sharing knowledge regarding a special technique, special niche, or particular approach helps all therapists in private practice.

Planning Session Ground Rules

PlanningMeeting
By Paul Martin, PT, MPT, CBI, M&AMI

REHAB COMPANIES THAT HOLD ANNUAL planning sessions are at the top of their markets and the industry. If at all possible, physically get the lead- ership team away from the office. You do not want to be distracted by day-to-day issues in your business. Whether you end up at a nearby hotel or an all-inclu- sive resort, everyone has to follow the same rules to get the most out of the planning process.

Board Service Award

Clem Eischen

THE PPS BOARD OF DIRECTORS IS PLEASED TO announce the recipient of this year’s Board Service Award— Clem Eischen, PT.

Clem has been a long time member of PPS, and his past roles have included serving on the Nominating Committee, Chair of the Legislative Committee, and past President of the Section. Clem was also very involved in the efforts to have physical therapist included in the Medicare program. In 1972, Clem was instrumental in forming the PT–PAC, which later transferred under APTA.

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