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  • 2015-02-February

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.

Expert Advice

Creating more profitable private physical therapy practices.

By Steve Takle, BA (Hons), MA

While there are most likely as many motivations for entering the physical therapy industry as there are therapists, the majority are inspired to complete their training to provide care for others. Whether this comes from an interest in the science and technology behind modern physical therapy practices or simply an altruistic intent to do good, it seems that most privately-owned physical therapy businesses are therapy first and business second.

However, that does not mean that “business” is a dirty word. It just means that practice owners tend to be therapists, rather than entrepreneurs. It is a mindset that is practically the default of nearly all academic institutions, where the business element of owning or managing a private practice is largely disregarded.

It is this mindset that physical therapists take into their professional career. As a result, many private practices lack the tools, knowledge, and ability to maximize the potential of their businesses. Paths to this information can be costly, time consuming, and off-putting with hard-nosed business advice, which seems a world away from providing the care that inspired a person to become a physical therapist in the first place.

It was precisely with this in mind that the first COPA Practice Growth was held in London, England, in 2013. The exhibition and conference was specifically designed to offer chiropractors, osteopaths, and physical therapists industry-specific business advice and insight, along with the latest rehabilitation research and products in the sector. The event was an instant hit with the European profession and doubled in size for 2014 to become Europe’s largest medical rehabilitation exposition. This year the event will be held March 4 and 5 at the Javits Center in New York.

COPA Practice Growth is designed for the private practice owner and is a business services expo specifically created to help successfully grow the practice and skills of the practitioner. The event aims to enable you and your business to grow, providing rehabilitation practitioners with expert advice, guidance and inspiration from experienced, successful sources. You will gain the knowledge you need to propel yourself and your practice to the next level.

These seminar sessions cover the most important developments facing rehabilitation therapy, with speakers ranging from leaders in medical to business experts and professionals—confirmed to speak are Henry Hoffman, Co-founder of Saebo and Dr. William Pawluck, electromagnetic field expert.

COPA Practice Growth is committed to providing advice and education to aid your professional development. Attending the exhibition and conference will contribute toward your continuing education units.

COPA Practice Growth will coincide with Neurological Rehabilitation Therapy & Technology, Elite Sports Therapy & Medical Rehabiltation; and Animal Rehabilitation Expositions.

To register for a free ticket to the expo, visit www.copaexpo.com

Steve Takle, BA, MA, is a freelance copywriter and editorial consultant in Bristol, England. He can be reached at hello@stevetakle.com.

Make an Action List

By Tannus Quatre, PT, MBA

If you are like virtually every other business owner in America, I know one thing about you: You try to do too much. Yep, I said it. You are an overachiever. You work too hard, you don’t like to say “no,” and you try to do everything at once.

One other thing I know about you is that sometimes you fail. Pushing yourself to your limits means that things fall off the plate from time to time, and sometimes you might not even know it happened.

While I know no cure for the overachiever, one simple trick that has helped many Type-A personalities is an action list. We have all heard it before, and there is a reason—it works.

Making an action list looks like this:

  • Commit to using an action list every day. This can include revising an existing list, or creating a new one from scratch. Write down an actionable item, which can be completed in its entirety that day. An example of an actionable item may be: “Return call from Mrs. Smith” or “Complete documentation for all daily patients.” If the action item pertains to a large project that will not be completed that day, write down only the portion that you will complete before nightfall.
  • Prioritize your list so that the most important and/or most achievable items are completed first. There is some psychology to this act: It is important that we see ourselves making progress throughout the day on our action items. Focusing on bigger, intimidating items, such as writing a new contract, before smaller more achievable items, such as returning a phone call, may be an inspiration killer that can demotivate even the most passionate go-getter.
  • Cross off items as you go. I am a techie and as much as I love my gadgets and apps, I make paper lists for one important reason: Nothing feels better than drawing a line through something I have accomplished. If you prefer to do this electronically, more power to you. However, whatever the method, make sure it brings you immediate pleasure that you want to replicate again and again.
  • Carry your list over from day to day. If you do not get something accomplished on your daily to-do list, do not despair. Also, do not forget it. Carry it over to the next day so that you have a means for not letting any important items fall from your radar.
  • By taking a few minutes each day to create an actionable workflow around your important to-do items, you’ll find that this small investment reaps big rewards toward your new end-of-day mantra, “Hey, I actually got something accomplished today.”

    Try it and let me know how it goes!

Promote a Greater “Health Span” for Your Patients

By Lynn Steffes, PT, DPT

As they age, our patients’ worries turn not only to the length of their lives but also to the quality of their lives. Physical therapy should be a big part of the new conversation about “health span” versus “life span.” As pointed out by Gregg Easterbrook in The Atlantic October 2014, “What Happens When We All Live to 100?” life expectancy in the United States has grown since 1840 from 47 years to 79 years. It is predicted that by 2100 it will be 100. “Indeed, the most exciting work being done in longevity science concerns making the later years vibrant, as opposed to simply adding time at the end.”1

Physical therapy remains one of the best solutions for addressing the need to stay active and vibrant as we age. We must emphasize that role as we educate our patients.

How can physical therapists begin the quality of life conversation with consumers? Use your functional outcome reporting tools or explore adding test items from the “Health-Related Quality of Life” (HRQOL) measure questions in your assessments www.cdc.gov/hrqol. That conversation can be an important strategy for marketing your therapy aftercare programs, wellness and fitness programs, and patient direct access for additional therapy at your clinic.

Some ideas might include offering:

  • Aftercare programs that help patients transition from therapy to fitness.
  • Automatic follow-up appointments for a “tune up.”
  • Fitness/wellness programs.
  • Fitness/wellness education via social media
  • Complimentary fitness/wellness lectures, classes, and educational tools.

Bridgit Finley, PT, DPT, OCS, FAAOMPT

Bridgit Finley, PT, DPT, OCS, FAAOMPT, is the chief executive officer and founder of Physical Therapy Central. She can be reached at bfinley@ptcentral.org.

Practice specifics (number of locations, employees, years in operation): We are having our 10-year anniversary this year and have grown from one location in Norman, Oklahoma, to 17 locations across Oklahoma. We have 42 full-time physical therapists and over 65 full-time employees. Most of the physical therapists that we hire have been our students. Each location has a clinic owner, which makes us unique.

What is the most influential book/person/event that enhanced your professional career and why? The One Thing changed the way I focus, work, and get things done. The authors condensed information from time management and leadership gurus and improved their original material. It is a must read.

Who are the most influential people in your career? Julie Whitman and Tim Fearon. They changed the way that I practice physical therapy. I have also been working with a business coach, Rob Wainner, and over the last six months it is amazing how far I have come with the ability to make decisions and communicate with my team.

Describe the flow of your average day. Do you treat patients and how many hours a day/week? When do you perform management tasks, answer emails, market? I see patients 16 hours a week (on Tuesdays and Thursdays) and on the other days, I mentor, run the business, and pursue growth opportunities. I really enjoy teaching and mentoring my team and more and more of my time is devoted to developing them. I continue to market the business, but I have purposely stopped doing the day-to-day tasks and delegate those duties to the local clinic owners.

Describe your essential business philosophy: My business philosophy is: growth at a controlled and systematic pace. Develop your people and promote from within. Always start with the right person and then find the right location to open a clinic. It is easy to say that you are a “people first” company and much harder to operate and make decisions based on those core values.

What have been your best/worst/toughest decisions? It was tough to close a clinic because of the people it affected. It was losing money and I knew that it had to be done, but it was difficult.

What is the best decision you have made? The best decision I have made was to partner with the best and brightest physical therapists to open clinics.

How do you motivate your employees? Author Dan Pink is my guiding light: I foster mastery, autonomy, and purpose. I treat each one of my employees just like I want them to treat my customers. We provide professional development and residency training so that they develop mastery. They enjoy their jobs because they are good at what they do.

How do you stay ahead of the competition? I had just opened my first location and I wanted some insight and information and a friend suggested that I join the Private Practice Section (PPS). The first conference I attended, I was hooked because of all the great friends I met and the great network I created.

I believe that the competition makes us better and stronger. It keeps us moving forward and does not allow us to settle. We focus on customer service, and expert, evidence-based physical therapy. Most of our marketing is internal marketing to our customers, who become lifelong consumers and consequently refer their friends.

I had to learn how to lead and feel comfortable in the chief executive officer position. I started the company and, at one time, had treated all the patients. I had to learn how to decrease my patient care hours. I love being a physical therapist and love working with patients. That decision is still very hard for me. However, the company was grown and I needed to step up and lead. I held on to patient care for too many years.

What are the benefits of PPS membership to your practice? I am always seeking out resources from the PPS section in terms of podcast, ideas, and information. For me, the most beneficial offering is the annual conference. I always learn something, have great networking opportunities, and enjoy seeing all the vendors.

What is your personal goal? My personal mission statement is simple: Do the right thing, treat people fairly, and pursue growth and learning. I never want to settle or stop improving.

What worries you about the future of private practice/what you are optimistic about? I think what worries me most is the uncertainty of health care and reimbursement. Health care dollars are shrinking, and we have to maximize our productivity. I am optimistic that people see value in physical therapy services, and if we can educate the public, I feel like they will choose physical therapy over surgery and/or drugs. We provide the best and lowest cost care for musculoskeletal conditions. We need to shout this out.

List at least one new opportunity you plan to pursue in the next year: Our company is continuing to grow and expand. This year we opened six clinics and next year we plan to do the same thing. 

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