Meet the Press

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They are your untapped referral source

By Ben Montgomery

When you think of your referral sources, who comes to mind? Physicians, specialists, clinical providers—they all serve as trusted professional partners who view you as a credible source for rehabilitation and pain management services, and likely much more.

Yet these sources live on a distinct island. They are some of your greatest advocates, but beyond their own line of patients, their reach is limited. Traditional referral sources can guide clients in your direction, but you cannot rely on them alone to tell your story, the story of your clinic, or the story of the physical therapy profession.

To tell such stories, you need a much wider megaphone—a credible messenger with an eager audience made up of a bold cross section of your local market. Regardless of where you are or the size of your market, such a megaphone does exist: It is your local press.

Loosely defined, “the press” is any person, company, or organization that produces content reaching a wide audience of readers, viewers, listeners, subscribers, and/or members. The channels they use to connect with their audiences vary from print publications and online blogs to television and radio, yet they all have one thing in common: the need for compelling content.

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That is your cue.

As a private practice physical therapist, you have value to add to the public conversation. The press wants your news, stories, expertise, and perspective—they need it, in fact, because such things are valuable to their audience, and hence offer value to their products.

Few writers, journalists, and assignment editors are experts on issues of exercise, functional movement, or overall lifestyle enhancement, so they are always on the lookout for credible health care sources. The goal of a media strategy is to create relationships and establish your credibility with such gatekeepers of content so you can fill this valuable niche.

As a natural educator, you as a physical therapist should thrive in this role.

Media relations is your opportunity to educate your community about yourself, your clinic, and the role physical therapy plays (or can play) in improving people’s lives. It is also a way to enhance your credibility in the eyes of your community at large, propelling you and your brand above others simply due to your willingness to speak up and share a little of yourself.

Needless to say, a consistent media relations strategy should be a part of every private practice’s marketing effort. It is your time to grab that media megaphone.

Here are a few tips to get you started

Be a media consumer: Read newspapers, watch the news, pick up a magazine, scan your chamber of commerce newsletter, and subscribe to the local blog for active moms. As you get better acquainted with your local media landscape, pay particular attention to who covers health and lifestyle news, what topics they are covering, and how you as a physical therapist might enhance the conversation.

Develop a media list: Do not make a list of places, but of people who cover health, lifestyle, sports, and business within your local market. If you cannot find their contact information online or in local publications, call the media office(s) for names and email addresses. Most are happy to oblige.

Create and share content: Share an inspiring story about a patient. Provide a physical therapist’s perspective on a trending news topic. Offer seasonal and consumer-ready tips or advice about exercise, movement, or injury prevention. Whatever you choose, consistent content (generally shared via monthly press releases) is your “in” with the local media.

Be available: Always make it a priority to keep communication channels with the media open and free of delay. Writers, journalists, and editors often work under the pressure of tight deadlines, and returning messages promptly will show them you are an eager and reliable source, perhaps opening the door to future contact. Also, they will likely return the favor next time you reach out to them.

Be consistent and realistic: Media relations is a long play. Not every press release you distribute will find its way online or in the paper, but it all contributes to building relationships, establishing trust, and keeping you top-of-mind with people in the press. It is a process that takes time and consistency—but one that can pay big dividends for you, your clinic, and the profession as a whole.

Ben Montgomery, a former journalist, applies years of copywriting and message development experience toward serving physical therapist through BuildPT, the recently developed marketing services arm of Vantage Clinical Solutions helping private practice clinicians develop media relations, email marketing, and online engagement strategies. He can be reached at ben@buildpt.com.

The Life-Changing Magic of Tidying Up

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How to organize your stuff.

By Marie Kondo | Reviewed by Deb Gulbrandson, PT, DPT

The book, The Life-Changing Magic of Tidying Up, may seem like a strange choice to review in a physical therapy journal but many of us are perennially challenged by “stuff” in our lives. This can impact our efficiency and decision-making ability. As business owners it is becoming more challenging to run a successful private practice. The fewer distractions we have, the more we can focus on the important things. The author Marie Kondo takes a Zen-like approach to the art of “tidying up” or reducing clutter. Whether our office, home, or even car, we all work and feel better when there is open space. Putting our physical environment in order positively impacts other aspects of our lives. We start by discarding; then we organize our space. 

An interesting aspect is to keep only things that spark joy in our lives. We hold onto unused items because they are still serviceable or we might need them someday. Kondo’s rule is to sort by category, not location. We assume we should organize by room or area. Kondo’s explanation is that we all have too much stuff. We need to collect everything in one place. For example, at home, search all areas to find items in the same category. For clothes search the laundry room, storage closets, etc. By collecting one category (and if you have too many clothes, subgroup into tops, pants, etc.), we really see how much stuff we have. In many cases there are duplicates that we do not even realize. Handle each item and see if it sparks joy. Keep only those that do. 

Discard in the following order: 

  1. Clothes
  2. Books
  3. Papers
  4. Miscellaneous
  5. Mementos

This order runs from least emotional to most emotional. We want to create momentum by working quickly through the discard phase so that when we get to the really hard stuff, we have honed our skills for what makes us happy. Kondo says in her book, if you start with mementos, you are doomed to failure. It is just too hard. 

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This approach includes conversing with the item, thanking it for its service to you. Now that may seem a little weird to us Westerners, but I like that idea. It seems to make it easier to let it go; even those purchases that I regretted. They taught me that I should not do that again. Kondo reports that by handling each sentimental item and deciding what to discard, you process your past. If you store or hide things away, before you realize it, your past becomes a weight that holds you back and keeps you from living in the here and now. This technique can be applied to our office, our files, and our email. 

Once you have discarded as much as possible, only then do you decide where to put things. Everything should be in one place, rather than multiple sites such as screwdrivers in the garage, kitchen, and/or laundry room. It is easier to remember and retrieve.

By reducing the clutter in our environment, we can see where to focus our attention. This allows us to put energy into making our businesses and lives as successful as possible.

Ben Montgomery, a former journalist, applies years of copywriting and message development experience toward serving physical therapist through BuildPT, the recently developed marketing services arm of Vantage Clinical Solutions helping private practice clinicians develop media relations, email marketing, and online engagement strategies. He can be reached at ben@buildpt.com.

Compliance 2.0

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Rebooting your compliance program.

By Nancy J. Beckley, MS, MBA, CHC

The compliance landscape for outpatient therapy looks remarkably different entering 2016 than it has for the past few years. For a lot of practices an “out of sight, out of mind” attitude has gravitated to an “I cannot sleep at night” feeling. So what has happened over the past year? What are steps a private practice should take to mitigate compliance risks? How does a provider reboot its compliance program to be sensitive to the risks that are unfolding in the market?

Profiling: Big Data, Public Databases and Transparency

In 2014, the Centers for Medicare & Medicaid Services (CMS) released calendar year (CY) 2012 data regarding reimbursement for physicians and other providers billing under the Medicare Physical Fee Schedule. This data release was part of the bigger picture of CMS transparency creating an opportunity for the public at large to get a glimpse at Medicare dollars and statistics.

CMS gave an advance copy of the data on provider Medicare reimbursement to the Wall Street Journal (WSJ), which in turn created “Medicare Unmasked: Beyond the Numbers,” a publicly available lookup tool1. Other publicly available lookup tools soon emerged, including ProPublica. Much of the early buzz and publicity focused on physicians and other providers, including physical therapists in private practice, receiving high reimbursement from Medicare. Feedback from the provider community at large prompted CMS to be more comprehensive in the release of the 2013 data. The WSJ lookup tool includes a comparison of 2012 data to 2013 data.

The entire database can be downloaded at CMS in the public use files section. After you download the database, you will be able to research the data. For example, you could determine top group therapy payments by state, the numbers of ultrasound procedures by state, or determine the ratio of evaluations to reevaluations, or any or all procedure codes. What you will not be able to tell by analyzing the data is how many physical therapist assistants (PTAs) contributed to an individual therapist’s billings and payments. You will not be able to tell which therapists are potentially allowing their Medicare provider number to be used by providers not enrolled in the Medicare program.

Have you profiled yourself? Have you profiled all the enrolled providers in your practice? Where do you sit in terms of Medicare codes billed in your state and in the country?

Table 1 shows a high-level summary of the top physical therapists in Florida that was researched with the WSJ lookup tool with respect to total Medicare payments in 2013. Note that the last column provides a comparison to 2012. What do you know after looking at this table?

Policy in the Making: Office of Inspector General (OIG) Opines in Audit Reports on Therapy Policy and Statutory Requirements

The 2016 OIG Work Plan once again includes a review of physical therapists in private practice and is captioned as “Physical therapists—high use of outpatient physical therapy services.” Per the Work Plan:

“We will review outpatient physical therapy services provided by independent therapists to determine whether they were in compliance with Medicare reimbursement regulations. Prior OIG work found that claims for therapy services provided by independent physical therapists were not reasonable or were not properly documented or that the therapy services were not medically necessary. Our focus is on independent therapists who have a high utilization rate for outpatient physical therapy services. Medicare will not pay for items or services that are not “reasonable and necessary.”2

The OIG notes reference the Medicare documentation requirements for therapy services in CMS’s Medicare Benefit Policy Manual, Pub. No. 100-02, Ch. 15, § 220.3. The OIG also included physical therapists in private practice in the 2011, 2012, 2014, 2014, and 2015 Work Plan under the Office of Audit Services (OAS). In addition to audits under the Work Plan the OIG initiated a widespread audit of 400 physical therapy claims nationwide in 2014 out of the OIG Chicago office. The findings as a result of that audit have not been published.

The OIG has published several reports on physical therapists in private practice pursuant to the OAS initiatives under the Work Plan. A report on a New Jersey provider was released in 2013, followed by an Illinois provider in 2014 and reports regarding providers from New York and Puerto Rico were released in 2015. Additional audits are under way so expect to see further audit reports in 2016.

It is important to know that in a recent report the OIG disallowed plan-of-care delayed Medicare certifications that were obtained per the statutory guidance and manual instructions contained in the Medicare Benefits Policy Manual. They also provided different interpretation to the element required in the plan of care than the CMS manual guidance. When the OIG presents its audit findings and report to CMS for recommended actions (contained in the report recommendations), there is an opportunity for the provider to plead their case with the CMS official assigned to the case. Following this step, the provider has a chance to stave off the “extrapolated” payment with timely filing of the first level of appeals. If unsuccessful at redetermination, timely filing at the second level of appeals (reconsideration) can stave off recoupment once again. Unfortunately, recoupment begins if the reconsideration is unsuccessful even if an appeal to the third-level Administrative Law Judge (ALJ) is initiated.

So what is in this for other private practices? If the providers that have taken their OIG audit findings through the appeals process on OIG findings and with their rationale are unsuccessful, there will be “new policy” that other contractors can use with respect to plan of care elements, delayed certification, and provider supervision. Note to readers: None of this had to do with medical necessity. In fact, the New York provider with an extrapolation payment demand had a 4 percent error rate on medical necessity. Stay tuned for further updates. And by the way, ensure compliance with timely certifications!

Love Letters on Billing: Comparative Billing Reports

December saw the release of the fourth comparative billing report (CBR) for 8,000-plus physical therapists in private practice. The purpose of this comparative billing report was to highlight “providers with a specialty of physical therapy and contains data-driven tables with an explanation of findings that compare these providers’ billing and payment patterns to those of their peers in their state and across the nation.” Per eGlobalTech, the CBR contractor for CMS, the goal is to “offer a tool that helps providers better understand applicable Medicare billing rules.”3

Physical therapists selected to receive the CBR report received an analysis of their Medicare fee-for-service for Current Procedure Terminology (CPT) codes 97001, 97035, 97110, 97112, 97140, 97530, and G0283 with dates of services in CY 2014. The individual physical therapist receiving the CBR were compared to a group of other “rendering National Plan & Provider Enumeration System (NPIs) in their state as well as to national peer groups.”3 The CBR information is only available to the therapist receiving the CBR, and the data is not publicly available in aggregated form, so there is not a summary of the findings. Individual therapists received the following comparative information:

  • Table of summary utilization of each of the codes that includes allowed charges, allowed services, beneficiary count, and visit count.
  • Percentage of beneficiaries with the KX modifier in CY 2014 and comparison with state and national peer groups.
  • Average allowed minutes for the selected codes for CY 2014 and comparison with state and national peer groups. (Note: Each unit was configured at 15 minutes, even though therapists bill per 8 minutes with the number of codes constrained by time.)
  • Average allowed charges per beneficiary for CY 2014 and comparison with state and national peer groups.

As noted, this was the fourth comparative billing report for physical therapists in private practice. Previous reports were issued in 2010, 2011, and 2012. CBR001 was issued to the top 5,000 physical therapists billing with the KX modifier in 2009. CBR008 was issued to the top 5,000 physical therapists billing with the KX modifier in 2010 who had not received a CBR in 2010. So by the second CBR report 10,000 of the “top” private practitioners billing with the KX modifier had been profiled. CBR018 was issued in 2012 to the original 5,000 individuals receiving CBR001. The first 3 CBRs profiled the same CPT codes as the current CBR with the exception of 97001 and 97035.

The previous CBR reports were completed under a CMS contract to SafeGuard Services, and the associated materials including the sample documents and webinar materials are no longer publically available due to the change in CBR contractors.

As noted, the therapy landscape has changed with respect to data transparency, provider profiling, and technical audits. Have you completed a compliance risk assessment? Have you profiled the providers in your group practice? Have you adjusted your compliance monitoring and auditing activities based on these risks?

References

1. Medicare Unmasked: Behind the Numbers: http://graphics.wsj.com/medicare-billing. Accessed November 2015.

2. 2016 OIG Work Plan: http://oig.hhs.gov/reports-and-publications/archives/workplan/2016/oig-work-plan-2016.pdf. Accessed November 2015.

3. eGlobalTech Comparative Billing Report: www.cbrinfo.net/cbr201511-sample-cbr.html.

Nancy-Beckley

Nancy J. Beckley, MS, MBA, CHC, is certified in health care compliance by the Compliance Certification Board and is a frequent speaker and author on outpatient therapy compliance topics. She advises practices on compliance plan development and audit response. Questions and comments can be directed to nancy@nancybeckley.com.

Blank Slate

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By Stacy M. Menz, PT, DPT, PCS

The start of a new year is like the first page of a brand-new notebook. The pages have not been written on yet and we get to create the story that fills the pages. It is a great time to sit down and strategically plan for the upcoming year. What were the goals you declared last year? Did you meet those goals? What are the goals that you want to achieve in the coming year? What do you want to change? What have you learned for the future of your practice?

The Private Practice Section Annual Conference each November is fortuitous in terms of timing. This event can be a catalyst to reflect on the past year; discuss ideas—as well as challenges—with colleagues; and attend presentations that may open your eyes to new systems, ideas, or perspectives that can benefit your practice. Discussing your past year with colleagues may help you to take a step back and reflect on the past year, and this reflection can help you look at things that happened a little differently.

Guiding the Way

Mentoring early career physical therapists in private practice

By Michael Gans, PT, DPT, OCS, FAAOMPT

Two years ago, I was having a discussion with our human resources coordinator who said that whenever she talked to doctor of physical therapy (DPT) students they always asked about mentorship within the clinic and company. She would ask them what exactly they are looking for in a mentor, and most could not put into words what they wanted or why. The physical therapy residency model has grown to 188 programs across the country, but have only graduated 2,129 clinicians since 1999.1 Some new clinicians would like to do a residency but cannot because of financial restrictions or the limited number of residency opportunities in their area. DPT students look for residencies because they want to advance their clinical knowledge and want mentoring from experienced clinicians. Our company designed a program to be similar to a residency model to attract motivated new professionals with two objectives: first, improve clinical reasoning; and the second, improve clinical outcomes for new clinicians.

Clinical reasoning is the cornerstone of physical therapy care. As health care providers, it is the way we navigate the patient examination to attain the appropriate plan for treatment. The ability to recognize patterns and develop hypotheses from the subjective examination is difficult for newer clinicians who have limited treatment experience. Integrating concepts from the classroom into patient care can sometimes be difficult, and longer clinical affiliations can give clinicians more perspective to draw from–changing their outlook.

The Hypothesis-Oriented Algorithm for Clinicians II2 (HOACII) was developed to assist students and clinicians with this essential thought process. As an organization, we utilize HOAC II as a guide to help these individuals build their clinical reasoning skills. Developing these skills and qualities does not happen overnight and the path from novice to expert clinicians is a difficult one. American novelist Mark Twain was credited with saying, “Good decisions come from experience. Experience comes from making bad decisions.” So how do we gain experience as clinicians without failing our patients in the process? Doody and McAteer studied the decision making of both novice and expert clinicians and found that novices spend significantly more time on the physical exam than experts.3 This is most likely due to the lack of pattern recognition, lack of experience, and a lack of hypothesis generation from the subjective examination. The goal of our mentorship program, as well as most residency and fellowship programs, is to help clinicians develop that clinical reasoning and pattern recognition more quickly and efficiently.

Our second objective was to improve clinical outcomes. New clinicians complete their doctoral training with the latest evidence in examination and intervention so we wanted to look to improve patient “buy-in” during the initial evaluation to improve patient retention. I ask each new clinician during our first education session, “what is the goal of your initial evaluation?” I get answers ranging from, “to find a treatment that is effective” to “determine a diagnosis” to “develop a plan of care.” Does any of that really matter if the patient never shows up for their second visit? Getting patients to invest or “buy in” to the treatment plan that you have developed with them is just as important as any of the above answers to this question. I have heard the argument that this is just practitioners trying to maximize profits and visits, but evidence exists to show that it makes a difference in patient outcomes as well. Ferreira in 2013 randomized 182 patients with chronic low back pain (LBP) to determine the effects of exercises and spinal manipulative therapy. They also assessed their therapeutic compliance with the Working Alliance Inventory, which assesses the patient’s perceived relationship with their treating therapist. When reviewing the data of the two groups based on the randomized treatment, the results were similar. However, when reviewing patients in each group by therapeutic alliance, the group with positive outcomes had a positive relationship with their therapist. When the patient and therapist have a positive relationship based on trust, mutual cooperation, and goal setting, the patients invest in their care and their outcomes subsequently improve.4

Another aspect of our program that we have examined and discussed through our inaugural 18 months is where continuing education fits into a residency model. Is it worth the money we spend? While participation in traditionally organized workshops and conferences improves knowledge and practice behaviors of the individual attendee, there is no corollary improvement in patient outcomes.5,6,7 Clinicians spend three years learning in a doctor of physical therapy (DPT) program and afterwards entry-level clinicians spend even more time learning through continuing education. Our solution is a structured continuing education program that offers both internal courses taught by our expert clinicians and courses external to our company in each of the body’s main regions (cervical/thoracic, lumbar, upper extremity, and lower extremity). Our internal education courses are taught quarterly and are presented by our own company mentors who specialize in their respective subject-area. Not only does this give new clinicians continuing education, but it also gives them a chance to see how they can rise within the company as a clinical expert/mentor.

To date, it has been difficult to measure the individual outcomes of this program over the past year compared with clinicians hired prior to the start of the program. There have been minimal changes to productivity and retention, however, while much of the data is ongoing, our “new” clinicians have reported improved satisfaction in the workplace and within their own practice. As our company moves forward, we have found growth and prosperity in this program and a surplus of applications from surrounding clinicians. While we have begun to limit the amount of applicants to take part in this model, having a “wait list” of prospective employees is a great problem to have.

Even though this model is a work in progress and would not work for every growing practice, setting, or state, I encourage company owners and private practitioners to find new and creative ways to challenge your clinicians. Improving clinical reasoning and patient “buy-in” will change your employees and, ultimately, your practice for the better.

References

1. American Physical Therapy Association: American Board of Physical Therapy Residency and Fellowship Education. 2005. http://www.abptrfe.org/Home.aspx Accessed October 2015

2. Rothstein JM, Echternach JL, Riddle DL. The Hypothesis- Oriented Algorithm for Clinicians II (HOAC II): a guide for patient management. Phys Ther. 2003;83:455– 470.]

3. Doody, C and McAteer, M. Clinical reasoning of expert and novice physiotherapists in an outpatient orthopaedic setting. Physiotherapy. 2002;88, 5, 258-268.

4. Ferreira PH, Ferreira ML, Maher CG, et al. The therapeutic alliance between clinicians and patients predicts outcome in chronic low back pain. Phys Ther. 2013;93:

5. Chipchase LS, Johnston V, Long PD. Continuing professional development: the missing link. Man Ther. 2012 Feb;17(1):89-91. doi: 10.1016/j.math.2011.09.004. Epub 2011 Oct 20.

6. Cleland JA, Fritz JM, Brennan GP, Magel J. Does continuing education improve physical therapists’ effectiveness in treating neck pain? A randomized clinical trial. Phys Ther. 2009;89:38–47

7. Overmeer T, Boersma K, Denison E, Linton SJ. Does teaching physical therapists to deliver a biopsychosocial treatment program result in better patient outcomes? A randomized controlled trial. Phys Ther. 2011;91:804–819.]

Michael Gans, PT, DPT, OCS, FAAOMPT, is the Connecticut Physical Therapy Association president, director of clinical excellence, and a physical therapist for Physical Therapy & Sports Medicine Centers in Connecticut. He can be reached at mike.gans@ptsmc.com.

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