Plan of Care

Dear Editor:

Ask any physical therapist, occupational therapist, or speech language pathologist (SLP) this question: “Of all of the things you do every day in your clinic, what is the most important?” Some typical responses are likely to include:

• “Educating my patients to help them understand their condition.”
• “Encouraging my patients.”
• “Evaluating my patient’s condition so that we can provide effective treatment.”

What you will never hear is “Writing up a good, solid plan of care.” In fact, if you ask, “How important is writing a plan of care?” you will likely hear:

• “Writing a plan of care is a waste of time.”
• “It takes time away from treating my patients.”
• “It is a necessary evil. Just another insurance scheme designed to deny claims.”

I recently created some controversy in a blog post when I wrote the following:

“With a well-designed electronic medical record (EMR), documentation is easier, but I am not sure that documentation itself will ever be easy. I am not even sure that it should be easy. How can it be, when you are trying to accurately and succinctly describe something very complex, like a patient’s condition?”

I believe the same thing is true with creating a plan of care (POC). It is hard to do well, but a well-designed EMR makes it much easier. A well-developed, rational, realistic, and professionally written POC is important for you and your practice, for the payer, and, most importantly, for your patient.

Comparing Against Plan

Business managers will often say, “How are we doing against plan?” because they are constantly comparing the company’s performance against a business plan. The plan will include standard measures for growth, margin, and profit. With experience, and as the plan is continually improved, it becomes an accurate forecast of future business performance. Loan officers and investors use the plan to decide whether or not the potential value of the company is worth the risk of a loan or an investment.

This is similar the business of physical therapy. We should be using our knowledge, experience, and clinical judgment to develop a rational, evidence-based, achievable plan for our patients that demonstrates the value of our services. A good plan of care will use evidence (patient reports of function, objective comparisons of reliable clinical measurements, and results from widely accepted, standardized functional assessment tools) to establish goals and forecast the frequency and duration of visits necessary to reach the goals. A well-written plan establishes value. A good EMR, like a good accounting system, will let you easily track and report on these measures to demonstrate progress against the plan.

Your Payers are Demanding It

Just like bankers and investors demand a business plan, our insurance payers are demanding treatment plans. Some payers are reluctant to pay for any claims, even legitimate claims for valuable services. But all payers would like to deny payment for unnecessary treatment. The problem is that they have a very difficult time understanding the difference between a good value and a bad value. We need to prove we provide good value.

Your Patients Deserve It

Creating a POC and sharing it with your patients regularly is a win-win. It should be used as a tool that you review with your patient to measure their improvement against your plan. It should include expectations for the patient and can help motivate and guide your patient to take personal responsibility. By reviewing the plan with your patient routinely and making sure your patient understands the plan, you can better guide them through their treatment.

A Plan Leads to Better Care

Creating a good plan and using it for “course corrections” separates a professional clinician from a technician. A well-thought-out POC can serve as a continuous improvement process. Reviewing the POC routinely, comparing against goals, and correcting assumptions that went into your plan as needed will help you create an effective treatment plan.

Good Plans Are Good for Our Profession

I wanted to be a physical therapist when I was 14 years old and love the profession. It took me a long time to look at the bigger picture and understand that physical therapy, occupational therapy, and speech are misunderstood, small niches in health care. Writing great POCs helps the whole profession providing a better understanding of us for our patients and payers.

How a Well Designed EMR Helps

A great POC can only be created by a clinician who uses their knowledge and skills, but an EMR can help guide you to include important elements in your plan and monitor progress against goals. A well-designed EMR also helps you manage your patient caseload, stay on top of myriad insurance and compliance requirements, and facilitate professional communication with physicians and patients.

You know the value of the care you provide to your patients every day. Creating a well thought out and documented Plan of Care demonstrates that value.

Sincerely,

Jerry Henderson, PT
Founder of Clinicient
jhenderson@clinicient.com