Change Makers

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Work toward creating a healthier society by promoting wellness.

By Jean Darling, PT, LAT

As changes take place in the health care system, the science of medicine and the art of healing continue to strike a balance. Our profession needs to participate by taking on the role of wellness professionals. We must be innovative in our approach to wellness as we position ourselves for the future of health care. We have all the tools necessary to succeed, and we need to practice them by being the conductors of healthy lifestyles in our communities.

At the World Economic Forum this year, the focus was on a new and rather upbeat topic: the need for countries to invest in health to achieve long-term economic growth. “The time is right to elevate the conversation on health,” said Robert Greenhill, the managing director and chief business office of the forum. “This year, there is a sense that the global economy is out of intensive care and embarking on rehabilitation. As we ask how, metaphorically, to improve the economy’s health, literally improving the population’s health is a good place to start.”

The Catch 22 of Health Care Reform

Can private practices meet obligations under compliance and reporting requirements and still turn a profit?

By Dan Alloway

Everyone is asking this question. The new normal for physical therapists is that every time Medicare adds another rule you are forced to spend yet more time coding, checking boxes, and defending your methods of care. If that is not bad enough, the pace of these new rules seems to be accelerating.

Let’s begin with the obvious problem: Increasingly, therapists’ attention and time are dedicated to writing books for payers instead of restoring the patient’s functional deficit(s). This tilts the practice economics dangerously into the negative. Practice costs are steadily increasing as payers chip away at reimbursements, while therapist production per treatment hour is declining because of the arduous and complex documentation requirements. Meanwhile, the payers are using their computers to see if you are following those requirements. They are checking your coding and how your patients are progressing. They are tracking your outcomes. You find yourself a Catch 22—you cannot spend less time treating your patients, but you still have to find a way to document all those treatments. It probably seems like the only answer is to work at night and on the weekends, which is what you are doing.

But there is a better way out of that box: technology. Use the technology available to you. At this point, the common response is is “We are using technology!” Or “We are documenting on computers!” Yes, you are using a computer, but you are using it as a “virtual typewriter” instead of using it as an analytical tool that is capable of substantially reducing documentation time? If computers can fly airplanes and drones, we can certainly, automate G-codes, physician quality reporting system (PQRS) coding, and treatment documentation that will allow you to return to patient care, which can never be automated.

These technologies are not available everywhere, but with a little research you can find systems that will reduce therapist touch time for G-code and PQRS reporting to 30 seconds and compose your notes in the blink of an eye.

So, if this prescription for success is obvious, why is the theme of this month’s Impact magazine: “Can private practices meet obligations under compliance and reporting requirements and still turn a profit?” Why isn’t this month’s theme, “Technology and the golden era of outpatient rehabilitation?” Why have we not made that jump? There are two answers to that question.

First, technology is difficult and expensive. Many EMR companies do not have the financial strength required to play at this level. The development and testing time are extensive.

Second, a concern that technology encroaches on the therapist’s clinical judgment exists—such as “physical therapy documentation should be hard. If it were easy, anyone could do it.”

Sadly, these types of comments are coming from some of the leaders in our industry. They do not seem to understand that we need to automate the mechanics of documentation, so that therapists can cure their patients. They don’t understand that technology does not threaten clinical judgment, it enhances it.

Computers accumulate and analyze data and then organizes that data, saving a physical therapist hours of work. Forward-thinking doctors in hospitals, such as the Mayo Clinic, are all over this new approach. They understand that there is no way to fulfill their mission without maximizing the use of technology. They understand that technology is used to identify and organize evidence. They also understand that technology is used to present medical professionals with evidence-based scenarios, enabling significantly more complex analyses than are possible any other way.

As outpatient rehabilitation embraces technology instead of dropdowns with checklists, we will alleviate the burdens of complex payer reporting requirements and usher in a new era of technology-driven, evidence-based capabilities—enabling significant gains in both treatment efficiency and patient outcomes.

Dan Alloway is vice president of Development Systems4PT. He can be reached at DCA@Systems4PT.com.

Finding a Better Way

Ideas

Innovation is key to creating a successful physical therapy clinic.

By Jerry Henderson, PT

“Without tradition, art is a flock of sheep without a shepherd. Without innovation, it is a corpse.” —Winston Churchill

IN CASE YOU HAVE NOT NOTICED, THE CENTERS FOR MEDICARE AND MEDICAID Services (CMS), the nation’s largest payer, have been busy. They are releasing aggressive health care reform programs at a breathtaking pace. Equally astounding are the regulatory hoops that rehabilitation practices must jump through to remain CMS compliant: continued therapy caps, manual medical reviews, functional limitation reporting, and multiple procedure payment reduction (MPPR). The list goes on.

As predicted, other commercial payers are beginning to follow suit, compounding the burden and risk. Noncompliance is not an option, but few therapists can see patients and keep an eye on every regulatory nuance without working around the clock.

Something’s gotta give.

All of the best innovations, like the discovery of electricity or the first rocket to the moon, share one thing in common: They were born out of a need to find a better way. As physical therapists, the future of our profession depends on finding a better way.

Innovate or Die

In health care, the status quo is no longer an option. The United States spends more on health care than Japan, Germany, France, China, the United Kingdom, Italy, Canada, Brazil, Spain, and Australia combined. This does not necessarily translate to better quality in return.

When the terms “Health Care Reform” and “Outcomes” started becoming popular buzzwords in the mid-90s, I predicted that reimbursement would soon be closely tied to patient outcomes.

It took much longer than I thought, but I was right. Functional limitation reporting and PQRS programs from Medicare are just the tip of the iceberg. Changes are happening continually and at an accelerating pace. Pay for performance is on the horizon.

Maintaining professional independence depends on your ability to comply with the new regulatory environment. In my view, this means fully innovating your processes, systems, and— most importantly—people.

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Innovation Tips

Trash the Policy Manual
At my first position as a staff physical therapist at a large hospital, I was asked to review the Policy and Procedure Manual for our department on my first day at work. It was full of, uh, stuff—including detailed step-by-step instructions on how to search for bombs in case of a terrorist threat.

After reviewing the manual, my supervisor asked if I had any questions. I politely told her that I was not qualified for my new position. She, of course, asked, “Why?” I answered that I was not brave enough to enlist for bomb-searching duties in the hospital.

Her response led me to believe she had not read the manual herself, so I showed her. She asked me to stay on anyway, and said that I could follow my cowardly instincts in case of a bomb threat without fear of losing my job.

You probably have an equally impressive policy and procedure manual in a three ring binder sitting somewhere in your office. You may not have opened it in years. You probably created the manual because of regulatory requirements, but you probably do not use it in your day-to-day operations.

Ditch your policy and procedure manual. Replace it with an operations guide, which articulates your practice’s critical administrative activities. Create checklists based on this guide that set expectations about specific tasks to be completed on a daily, weekly, and monthly basis.

This is different than a system that optimizes therapist workflow. This simple checklist maps out the key routine administrative tasks necessary to running a healthy compliant practice.

Think daily and weekly routine—not protocol for every situation under the sun.

Automate, Automate, Automate
Even with a good operations guide in place, it is still almost impossible to keep up with regulatory requirements without a system that automates as much of your workflow as possible.

An automated system cannot think for you, but it can provide helpful guidance. For example, establishing and documenting medical necessity requires the decision making of a trained physical therapist. A well-designed workflow software should embed processes that automatically track and alert physical therapists to tasks that they must complete to be compliant.

An automated workflow system must also be totally integrated, meaning all of the information from your clinical documentation, claims, and patient accounts lives in one place. This system integration is important because it makes sure that clinical documentation supports claims.

Integration is not enough. Your automated system must also provide instant access to the information. How can you tell if you have enough access? If you find yourself calling, emailing, walking to the front desk or billing office to access information routinely, you don’t have a good system.

Workflow automation takes the guesswork out of Medicare compliance and frees your therapists up to provide great care. They should not waste their time understanding the intricacies of the 8-minute rule and national correct coding initiative edits.

Invest in Clinical Leadership
The most refined processes and best workflow automation are useless without great clinical leadership. My tenure at Clinicient has afforded me a unique opportunity to observe the management of hundreds of physical, occupational, and speech therapy practices all over the country. These practices range from small to large and represent a wide variety of clinical specialties. The one thing that distinguishes successful, innovation-friendly practices is the quality of their clinical leadership.

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Great clinical leaders must be clinicians. The most brilliant nonclinical business strategist or accomplished business manager cannot get a group of clinicians to adopt new processes or systems. Clinical leaders must translate the “big picture” to clinical staff, which is nearly impossible to do without being a clinician yourself.

Great clinical leaders must also communicate with transparency. They should never try to shield staff from all of the “dirty details” about the decision-making process that led up to changing a system or process. Instead, their communication should be grounded in experience and at least some scientific rationale.

Great clinical leaders also know what they do not know. When it comes to introducing new processes and systems, they will seek out the advice of other business and management professionals. They will hire a knowledgeable compliance consultant when needed. They will make sure they hire the best people for their billing office and front desk. They know it is worth it to pay a little more to build a staff that can embrace innovative ideas.

Innovate for Practice Independence
I knew that I wanted to be a physical therapist at the age of 14. But after I finally became one, I was not able to provide the care my patients deserved because documentation, compliance, and general bureaucracy ate up all of my time.

In hindsight, this frustration was a blessing, because it gave me the inspiration I needed to innovate. You do not have to start your own company to help colleagues find a better way. You just have to be willing to do things differently. Investing in fresh processes, workflow automation, and good people is the first step.

Jerry Henderson, PT, is vice president of Therapist Success at Clinicient. He can be reached at jhenderson@clinicient.com.

New Layer of Care

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Consider integrating health and wellness coaching into your practice to improve patient compliance and outcomes.

By Linda Gogl, PT, DPT, OCS, CWC, CWP

Health care providers now practice in a rapidly changing landscape. In fact, the ground is shifting beneath our feet. To remain successful and profitable as a business and practitioner in America we are forced to navigate through uncharted waters manning the helm as best we can and attempting to “stay steady as she goes.”

The Affordable Care Act and other payer reforms are changing how health care is delivered and reimbursed—rewarding organizations that can deliver better patient-level results while often treating a greater volume. Much of this has been driven by the climbing cost of health care and has prompted a new model of delivering care with a focus on timely results. Health care providers are now held accountable for practice outcomes and will be reimbursed according to efficiency and skills in producing those outcomes.1

Creating Practice Opportunities

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Using job requirements as the foundation for an effective warm-up program.

By Deirdre Daley, PT, DPT, Laurie J. Johnson, PT, Lisa Krefft, OTR/L, and Margot Miller, PT

Employers have been on the fast track to implement fitness and wellness programs ever since the Department of Health and Human Services (HHS) issued its final rules on employment-based wellness programs in May 2013, effective for plan years beginning on or after January 1, 2014.1 The rules support workplace health promotion and prevention as a means to reduce the burden of chronic illness, improve health, and limit growth of health care costs to our nation. At a time when there is more competition for available jobs and an aging workforce, promoting employee health and fitness is key to a company’s success.

Private practice physical therapists have an opportunity to provide employment-based wellness programs, meeting employer and employee needs, while driving bottom line revenue for the practice.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.