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

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