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Nov 2017 Newsletter: Teaching Documentation in a DPT Program

November, 2017 Newsletter

Teaching Documentation in a DPT Program

by Tiffany Enache, PT, DPT, Assistant Professor and Director of Clinical Education

Documentation is an important part of the daily life of a physical therapist, and APTA presents high standards in their Defensible Documentation resources (1) and also in the Guide to Physical Therapist Practice (2).  These both serve as very useful resources when designing learning experiences related to documentation in a Doctor of Physical Therapy (DPT) curriculum.  There are many challenges in teaching physical therapy documentation in a DPT curriculum, one of which is the variety of templates that exist throughout differing clinical settings, both in written template format and in electronic format.  Students in our DPT program expressed confusion when each faculty member introduced a new documentation template for their specialty setting, and the students similarly struggled to produce high-quality documentation in the clinical setting during their internships.  Our DPT faculty therefore sought to create a template that could be utilized across all physical therapy settings: from outpatient orthopedics to neurologic to pediatric to acute care.  The faculty standardized the way that we teach such aspects as goal writing and narrative assessments, and encouraged our students to be descriptive in the ways that they write about current level of function, motor control, and functional mobility.  With one consistent framework for teaching documentation, our students grew in skills and articulation, and documentation shifted from a curricular weakness to a curricular strength.

The final remaining challenge was to utilize an Electronic Health Record (EHR) system to teach documentation.  Even though our students were demonstrating significant improvements in their documentation skills, the way that we were teaching documentation, as one student stated, “needed updating”.  In the search for an EHR that would meet our needs, there were several features we were looking for: 1) a template that was intuitive enough for both novice learners and faculty; 2) a template that included sufficient breadth to cover all physical therapy settings; 3) a template that encompassed the high standards presented by APTA; 4) an interface that would pass university internet security review; 5) an interface that would be compatible with the academic learning environment; and 6) a company that would be willing to price their product fairly, considering that it would not be used to generate revenue.  

The DPT academic faculty excluded many EHR systems due to price, a common finding being that there was either no price model available for a usage that did not involve billing, or the base price significantly exceeded the budget of the department and would therefore increase the financial burden on the students.  The next triage of exclusion related to the template design.  Now that our students were finally understanding documentation standards, we felt it critical that we not lower our standards in order to embrace the EHR world.  We became increasingly frustrated as we reviewed templates that either lacked high standards, did too much of the work for the student (thereby decreasing their clinical reasoning), or were not usable across different physical therapy settings (many EHRs are built for the outpatient adult orthopedic population).  We struggled to find an EHR company that was willing to customize a template for us, especially considering our financial constraints.

Our solution was bestPT by Billing Dynamix.  From the very first conversation, their sales team was willing to listen to our needs and offered to create a template that met all of our requirements at a fair price.  Even though they had never before offered their EHR for use in the academic setting, they saw the value not only in this collaboration, but also the value in educating future professionals in the field.  We currently use Billing Dynamix for various classroom activities.  For example, students early in the program will enter data into the EHR as their professor conducts a patient examination in front of the class.  This is an excellent introductory learning activity because the instructor can then use the EHR to write up his/her initial evaluation, then spend class time explaining their choice in wording, the location of particular content, and how a narrative assessment, goals, and treatment plan are constructed.  Intermediate and advanced students in the program use the EHR during simulated patient encounters, and are graded on their documentation content and structure.  Future hopes for this EHR include use at the program’s pro bono clinic.  We have been able to construct our EHR templates to give just enough prompting to provide guidance to novice learners, yet not so much prompting such that students would lose the opportunity for development of clinical reasoning and professional language.  

Thank you, Billing Dynamix, for this collaboration.  You are helping to elevate the standards for future DPT professionals!  I look forward to a longstanding relationship with your company.

Tiffany, PT, DPT

(1) http://www.apta.org/Documentation/DefensibleDocumentation/

(2) http://guidetoptpractice.apta.org/

 

 


 
Let’s welcome bestPT Billing’s newest members!
Harry Morgan & Samantha Andrew
 
Mallory Boyd & Stephanie Petrycki
Bit-by-Bit Therapy, Ft Lauderdale, FL
 
Stephanie Grace
 
Amanda Newman
 
Walden Parsons
Integrated Mechanical Care, Sandy Springs, SC
 
Travis Smith
O&W Enterprises,  Stanleytown, VA
Melissa Talley, Roslyn Evans, Carol Howder,
Joanne Principe, & Lisa Ingenito
 

Each new member benefits from and contributes to our network strength.

 


 Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each friend that you refer that joins our network, we’ll credit you $50 each month the office is contracted with us through the first year!



Oct 2017 Newsletter: How the Cloud Protects Your Practice in a Disaster

October, 2017 Newsletter

Protected by the Cloud

The Cloud Protects Practices From Mother Nature

by Terry Douglas

As Irma devastated Florida’s Atlantic and Gulf coasts, I was reminded of how valuable it is to have your entire practice’s data securely stored in the cloud-far away from the rain, devastating winds, and storm surge.
With the destruction left in the wake of hurricanes Irma and Harvey, it is wonderful to know that cloud technology is helping people worry less and avoid further damage.
Here are four disasters modern medical practices across the southern U.S. will sidestep in the storm aftermath…

 


 
Let’s welcome bestPT Billing’s newest members!
Tiffany Enache
University Of New Mexico,  Albuquerque, NM
 
Vanessa Ruiz
 
Angelina Ferrel
Melwood Rehabilitation Center, Upper Marlboro, MD
 
Chelsea Parson
Asbury University, Wilmore, KY
 
Margot Connole
Health Rehab Solutions,  Kalispell, MT
 
Jamal Alian and Robin Walker
Basis Whole Body Wellness, Palm Beach Gardens, FL
 

Each new member benefits from and contributes to our network strength.


 Looking at the landscape of physical therapy practice management, we see a playing field tipped to benefit the payers and hurt the provider. The relationship between payers and providers is adversarial, but billing networks offer solid strategies that allow providers to get back into–and win–the game.

The “network effect” allows a large number of unique providers to capitalize upon their strength in numbers.  Please help us strengthen that network.

If your friend schedules a demonstration of the system, we’ll send you a $25 Amazon gift card
For each friend that you refer that joins our network, we’ll credit you $50 each month the office is contracted with us through the first year!



KEY HABITS FOR SUCCESS IN 2017

What are the habits that a physical therapist needs to accelerate their progress towards success? Working with some of the most successful clinic owners in the country, and by identifying what they want to achieve, Erika Trimble has identified what the 10 key successful habits are for clinic owners who want to live their professional dreams.

To read more, click here: Success Habits of Business Owners in 2017

physical therapy billing software ICD-10 cartoon

A New Online Learning Tool On How to Reduce ICD-10 Transition Pain for Physical Therapy Practice Owners

ICD-10 GEMs PLUS Solution Is Now Available with bestPT Billing and EHR Software

bestPT Billing and EHR Software helps their clients make a smooth transition to ICD-10. Their 5 part strategy called bestPT GEMs Plus ensures that Physical Therapists make the best ICD-10 code selection. bestPT’s code selection tool remains effective beyond the transition helping practice owners to keep up with continuous changes inflicted by insurance companies. Click here to learn more.

According to Dr. Eldad De-Medonsa, bestPTs’ President and PhD in Artificial Intelligence, the effects of the transition to ICD-10 will remain unknown for some time. “The only thing that is certain about the transition to ICD-10 is that insurance companies leverage its challenges and uncertainties to delay longer and underpay more insurance claims. Because of a huge increase in the number of codes, a simple one-to-one mapping between the old and the new codes does not exist, as demonstrated in the standard GEMs tool. We leverage the cloud, billing experts, and Artificial Intelligence to analyze millions of insurance claims and generate effective transition rules,” says De-Medonsa.

Click here to learn more.

About BestPT and Billing Dynamix, LLC.:
BestPT by Billing Dynamix is a comprehensive cloud-based Physical Therapy Practice Management system that includes intuitive EMR, industry-leading billing, scheduling, and powerful yet simple workflow management. Save documentation time and keep legible and compliant documents. Automate claims and leverage over 2.5 million coding rules spanning 2,500 practice-years of experience. Reduce administrative overhead and foster staff teamwork. bestPT is the ONLY Physical Therapy clinic solution that reduces administrative time by 70% compared to industry averages – GUARANTEED. Complete practice management consulting and a rich array of integrated products and services round out bestPT product and service packages. Register for a private Demo+, and review our industry-leading guarantee.

physical therapy billing cartoon

A New Online Learning Tool On How to Accelerate Physical Therapy Practice Growth Using Checklists

Checklist Technology Is Now Available in bestPT Billing and EHR Software

Practice owners fail to control and scale up patient visit experience when they rely exclusively on their memory and do not measure their practice performance. Without measuring, practice owners do not know that they have a revenue or a patient retention problem. Learn about it here.

According to Jason Barnes, COO for bestPT Billing and EHR Software, the first step in building any repeatable and scalable process is to define process performance and uniformity metrics. “The tasks are grouped together in a category for tracking purposes. The tasks can then be measured using the Task Manager Console across all patients or filtered down to a patient, to measure the success of the process across the practice or with an individual,” says Barnes. “For instance, the patient intake process might have 10 steps. If one of the steps is neglected, the problem would be manifested by the Task Manager Console reading a completion rate of 90%. The tasks can be sorted and the offending task can be rooted out and either changed or have additional staff training to achieve better results.”

Learn about bestPT Billing and EMR Software checklist technology here.

About BestPT and Billing Dynamix, LLC.:
BestPT by Billing Dynamix is a comprehensive cloud-based Physical Therapy Practice Management system that includes intuitive EMR, industry-leading billing, scheduling, and powerful yet simple workflow management. Save documentation time and keep legible and compliant documents. Automate claims and leverage over 2.5 million coding rules spanning 2,500 practice-years of experience. Reduce administrative overhead and foster staff teamwork. bestPT is the ONLY Physical Therapy clinic solution that reduces administrative time by 70% compared to industry averages – GUARANTEED. Complete practice management consulting and a rich array of integrated products and services round out bestPT product and service packages. Register for a private Demo+, and review our industry-leading guarantee.

physical therapy billing cartoon

Physical Therapists Now Use bestPT’s Workflow System to Manage Revenue Cycle and Improve Billing Processes

bestPT adds powerful new reporting features to its revenue cycle workflow control software to help practice owners improve collections and profitability

CLEARWATER, FLORIDA (PRWEB) JUNE 21, 2015

bestPT simplifies revenue cycle management through the use of it’s revolutionary workflow management process. More money to the practice creates financial stability for the owner and the employees and results in a stronger practice that is able to grow and serve more patients. Transparent reporting includes real-time automated alerts to notify process owners and participants about any problems or delays. This system enables practice owners to keep track of their claims, along with all other relevant work, in a single location. bestPT helps practice owners create a systematic revenue cycle management improvement process while providing them complete quality monitoring and control. View our free webinar here to learn more.

See exactly which claims were underpaid or delayed, and what needs to be done to fix that.

According to David Alben, the princial consultant at Genco Healthcare Management, the efficiency of bestPT system is the reason why their reimbursements are paid in full and on time. “Which claims have been paid and which claims haven’t been paid? Who owes you the money? How long have they owed you the money? The whole issue between insurance approved amount and usual and customary charges. All of those things are confusing. Insurance companies have placed barriers to payments because it’s in their interest to do that.”

According to Tom Jorno, PT Excellence Center Director at Billing Dynamix, bestPT’s Revenue Cycle Workflow automates the process of claim submission, follow up, and control. “Claims are automatically created with a preselected fee schedule and scrubbed against millions of rules prior to submission,” says Jorno. “The software allows them to see exactly which claims were underpaid or delayed, and what needs to be done to fix that.”

At the end of the day, bestPT summarizes all of this information into a single metric that can be monitored helping ensure that no claim is left behind and every underpayment or delay has been followed up on. The practice only has to clear one backlog a day with specifically worded instructions to maximize revenue. Any claim not addressed is easily identified by both practice stakeholder and practice success coach to locate the breakdown in process or ownership. Click here to sign up for the free webinar about bestPT’s workflow.

About BestPT and Billing Dynamix, LLC 
BestPT by Billing Dynamix is a comprehensive cloud-based Physical Therapy Practice Management system that includes intuitive EMR, industry-leading billing, scheduling, and powerful yet simple workflow management. Save documentation time and keep legible and compliant documents. Automate claims and leverage over 2.5 million coding rules spanning 2,500 practice-years of experience. Reduce administrative overhead and foster staff teamwork. BestPT is the ONLY Physical Therapy clinic solution that reduces administrative time by 70% compared to industry averages – GUARANTEED. Complete practice management consulting and a rich array of integrated products and services round out bestPT product and service packages. Register for a private Demo+, and review our industry-leading guarantee.

physical therapy billing and patient scheduling

Physical Therapists Now Use bestPT’s Scheduling Workflow to Manage Patient Relationships

bestPT’s software adds patient appointment quality control to help practice owners improve patient experience

bestPT simplifies scheduling and patient relationship management through the use of it’s revolutionary workflow management process. This system enables practice owners to keep track of their patient visits, along with all other relevant work, in a single location. bestPT helps practice owners create a systematic patient relationship management process while providing them complete quality monitoring and control.

According to Nick Roselli, OTR/L, CHT, owner of NR-OT network of Occupational Therapy practices, the efficiency of bestPT system is the reason why their reimbursements are paid in full and on time. “Do I take this insurance patient and lose money or do I turn them away and risk losing a referral source? That’s everything. You talk about efficiency? That’s efficiency with bestPT.”

According to Tom Jorno, PT Excellence Center Director at Billing Dynamix, bestPT’s Scheduling Workflow automates the process of patient appointment scheduling, follow up, and control. “…it allows the practice owner and their staff to see precisely which patients require attention on any given day. The software allows them to see exactly which patients missed their appointments, which ones don’t have a future appointment scheduled, and what needs to be done to fix that,” says Jorno.

That’s everything. You talk about efficiency? That’s efficiency with bestPT

At the end of the day, bestPT summarizes all of this information into a single metric that can be monitored helping ensure that every missed appointment and every patient without future appointments has been followed up on. Click here to sign up for the free webinar about bestPT’s patient no-show workflow management.

About BestPT and Billing Dynamix, LLC
BestPT by Billing Dynamix is a comprehensive cloud-based Physical Therapy Practice Management system that includes intuitive EMR, industry-leading billing, scheduling, and powerful yet simple workflow management. Save documentation time and keep legible and compliant documents. Automate claims and leverage over 2.5 million coding rules spanning 2,500 practice-years of experience. Reduce administrative overhead and foster staff teamwork. BestPT is the ONLY Physical Therapy clinic solution that reduces administrative time by 70% compared to industry averages – GUARANTEED. Complete practice management consulting and a rich array of integrated products and services round out bestPT product and service packages. Register for a private Demo+, and review our industry-leading guarantee at http://bestptbilling.com/

PQRS

2015 Changes in PQRS Reporting Made Easier with EMR

Previously we discussed the changes in health care provision regarding the Physician Quality Reporting System (PQRS). In this article I will present more in depth current information regarding the ever changing landscape of medicare reimbursement and how physical therapists fit into the picture. In January of this year, the US department of Health and Human Services (HHS) produced the first set of timelines for a transition away from Medicare reimbursement as we know it. The ball is now rolling to move away from a fee-for-service model in favor of a payment for outcomes paradigm. This new model will create a demand for provider accountability and increased quality in patient care in an outcomes-based reimbursement model.

The major changes in PQRS reporting for 2015 drastic changes in fee schedule payment. Specifically, private practice PTs who did not participate in successful reporting of data on quality measures in the form of PQRS reporting in 2013 will see a 1.5% reduction in their fee schedule payment in the year 2015(1). Those who do not successfully participate this year will be see a 2.0% reduction in their fee schedule which will be fully realized in the year 2017.

Additionally, private practice’s will be included in a Value-Based Modifier (VM) program which is set to begin in 2016. Under this new program, PTs must meet PQRS reporting requirements or be subject to up to a 4.0% reduction in payment in addition to the pre-existing 2.0% reduction for a total of 6.0% reduction in pay which will be realized in the year 2018.

The intention behind all of this change is that health care practitioners, including PTs, will provide higher quality services for Medicare beneficiaries. PQRS reporting began in 2007 and in the year 2011 was re-branded and tuned up through the Affordable Care Act. In 2013 it morphed from an incentive-based program to a penalty based program. There is no going back to where we came from, PQRS is here to stay, and a fixture of outpatient physical therapy practice(2).

Interestingly, the VM program utilizes PQRS data collected from clinicians to determine its penalties. Currently, physicians are experiencing these penalties, though the Center for Medicare Services (CMS) has held off on penalizing allied healthcare professionals in order to give adequate time for us to familiarize ourselves with the reporting system. Next year however, we will be held to the same standards, and in order to continue to draw in revenue as we have in the past, we must be compliant with the reporting format.

The regulations are doable. As PTs we must report at least 9 measures, which includes at least 3 National Quality Strategy (NQS) domains on at least 50% of Medicare Part B fee-for-service patients. A complete list of PQRS registries can be found at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Registry-Reporting.html. Depending on the type of patients your clinic sees, some of the domains may be satisfied rather easily with patient intake forms as these include a complete checked list of medications, a pain assessment prior to initiation of patient treatment, and a functional outcome measure. The first two are easily satisfied with patient intake, and the latter may be performed as part of the evaluation of a new patient, and thus readily satisfy Medicare PQRS requirements.

 

There are notable changes in the 2015 reporting, including which cases are eligible for reporting. These changes include elimination of the Back Pain measures group, as well as the Wet to Dry Dressing In Patients with Chronic Skin Ulcers. G code G8406 Diabetic Neurologic Evaluation was removed as well, while G codes G8980, G8983, G8986, G8989 and G8992 were added for FOTO outcomes measures #217-2231.

Medicare PQRS physical therapy

Use of Code #245 is still acceptable in PQRS reporting.

To check your status as a provider, and your clinic’s success in PQRS reporting, the CMS provides claims-based participants with feedback reports through Quality Net, the contracted service provider for Medicare. Visit qnetsupport@sdps.org or call 866-288-8912 to verify that you are on track for a successful reporting year. You may also receive feedback in the way of an Individuals Authorized Access to CMS Computer Services (IACS) account from Quality Net. You can set up an account at www.qualitynet.org/portal/server.pt/community/pqri_home/212#.

Of the two methods of reporting PQRS, the registry reporting method is quickly gaining traction. This may be due to increases in claims based requirements. Thankfully, the American Physical Therapy Association (APTA) has several resources available to ensure successful reporting. A comparison of the registry based reporting versus claims based reporting may be found at the APTA website: http://www.apta.org/PQRS/(3).

Additionally, the Physical Therapy Outcomes Registry is reaching finalization and will provide outpatient PTs with an organized system for collecting data to evaluate patient’s function, in addition to other relevant measures1. This collective data will demonstrate the value of physical therapy in the betterment of our patients. Furthermore, this data may be a highly beneficial tool in our continued advocacy for lightened Medicare Caps, better reimbursement, and improved professional image. More information on this registry may be found at: www.PTOutcomes.com.

All things considered, the essence of all of these changes is to provide the highest quality care for our patients. By demonstrating progress in our patients through functional outcomes measures, we are able to show the value that physical therapy holds in the lives of our patients. What we have intrinsically known for decades, we will now be able to show to Medicare, to our patients, and referral sources.

  1. Smith, H. Compliance Matters. PT in Motion. (8-12) April 2015.
  2. Registry Reporting . Center for Medicare Services. Available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Registry-Reporting.html. Accessed on April 20, 2015.
  3. Medicare Physician Quality Reporting System. American Physical Therapy Association. Available at: http://www.apta.org/PQRS/. Accessed on April 20, 2015.

-Amanda Olson, DPT

PQRS

Meaningful Use and PQRS

In 2012 the United States Department of Health and Human Services released final rules related to Electronic Health Records (EHR) and Health Information Technology (HIT). The rules require health care practitioners falling under the title of a physician to comply with federal laws, under the title Health Information Technology Act from Congress. The act made it so that pretty much all health care providers except PTs will have to upgrade EHRs to remain compliant through what is termed “Meaningful Use.”1 This list includes medical doctors, osteopathic doctors, podiatrists, optometrists, oral surgeons, dentists, and chiropractors.

The act also specifies payment adjustments for entities and providers that do not meet meaningful use requirements and other program requirements. Physical therapists are not yet defined as eligible professionals for demonstrating meaningful use and, therefore, are not subject to these payment adjustments for failing to demonstrate meaningful use. The American Physical Therapy Association reports that once a while at this time physical therapists are not directly affected by the rules related to meaningful use under Medicare and Medicaid, they should remain aware of issues relating to HIT technology, particularly in this dynamic health care delivery environment.

Thus, outrageously this new act allots credit to these aforementioned eligible health care providers to receive incentive payments (financial reimbursement) for achieving Stage 2 meaningful use requirements of the act with their certified EHR systems. Physical Therapists were not included, yet Chiropractors were. This is interesting, considering that physical therapists coordinate care and provide services by way of direct referral from hospitalists, specialists, and family care physicians at a much more frequent rate than chiropractors do.

As a pelvic practitioner, I exchange images, documents, and prescriptions on a daily basis with primary care physicians, oncologists, gynecologists, obstetricians, general surgeons, gastroenterologists, nurse practitioners, physician assistants, osteopaths, midwives, orthopedists, and naturopath physicians. I am not unique, all outpatient PTs see patients from a wide variety of practices, and all of these folks have been mandated to comply with the Health Information Technology Act. In a few years it is speculated that the various electronic health record systems will communicate with each other, thus physicians from various hospital and clinical settings will be able to access charts and images for any given patient. There are Electronic Health Records that are certified through the Office of the National Coordinator for Health Information Technology (ONC) Health IT Certification Program. This program helps to ensure that health IT conforms to the standards and certification criteria adopted by the Secretary of Health and Human Services.

We as PTs are faced with an interesting financial paradigm. We are not mandated to participate in the use of Electronic Health Records, nor do we receive financial reimbursement for its use. Yet, all of our colleagues and referral sources will be participating in this program and accessing patient information seemingly seamlessly, without faxing a pile of documents back and forth with each other.

The question becomes, how do we as PTs respond? The PTs who do switch over to an approved electronic health record system may face the realization that referring physicians do not want to fax piles of documents back and forth with non-participating PTs when they can easily and seamlessly communicate information and prescriptive paperwork with PTs who do have and ONC approved EHR system. Hospital based PT systems are by and large participating and compliant in electronic health records and PQRS reporting and may benefit from increasing referrals by other participating practitioners.

On a professional level, the PQRS reporting by PTs demonstrates our value to our patients, third party reimbursement, and referring physicians. Because the reported values are based on functional outcomes measures we are able to objectively quantify the good that we do for our patients. It is a given that for certain oncological, cardiopulmonary, and geriatric diagnosis the goal may be to preserve current function instead of to progress, we may look to patient quality of life (QOL) outcomes measures as well to demonstrate that we have effectively done our job.

BestPT_Medicare_G-codes_functional_outcome

Functional Outcome Reporting

The pain points of all of this are that PTs in the private practice sector may face decreased referrals from physicians for choosing not to participate in EHR and PQRS reporting. Meanwhile, at this time we do not receive medicare credit or immediate financial repercussion from ONC approved use of EHR from our compliance with this act either. The APTA spells it out for us: once in a while physicians and hospitals are the beneficiaries of many of the federal government’s initial efforts to encourage EHR system adoption, they will expect the other providers they work with, including physical therapists, to implement it as well. Patients also may begin to expect their providers to use EHRs to manage their care. It appears that the writing is on the wall, and that it would benefit outpatient physical therapists greatly to comply, lest we be swept out to sea without the support of our referral sources.

BestPT_Medicare_G-codes_measure154

BestPT is an ONC certified Electronic Health Record software and a sustainable solution to this paradigm. Visit APTA’s HIT webpage for resources and updates on HIT program development and legislation, as well as APTA’s related advocacy efforts.

BestPT_Medicare_G-codes_status_and_goals

Medicare Compliant Reporting

 

References:

1. Final Rules on EHR Meaningful Use Incentive Program and HIT Standards Released. PT in Motion News. Available at: http://www.apta.org/PTinMotion/NewsNow/2012/8/24/EHRHITRUles/ Accessed on April 1, 2015.

2. Physician Quality Reporting System List of Eligible Professionals (PQRS). Center for Medicare and Medicaid Services. Available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/PQRS_List-of-EligibleProfessionals_022813.pdf. Accessed on April 1, 2015.

3. Health Information Technology. APTA. Available at: http://www.apta.org/FederalIssues/HIT/. Accessed on April 1, 2015.
About the ONC Health IT Certification Program. ONC Health Certifcation Program. Available at: http://www.healthit.gov/policy-researchers-implementers/about-onc-health-it-certification-program. Accessed on April 1, 2015.

4. About the ONC Health IT Certification Program. ONC Health Certification Program. Available at: http://www.healthit.gov/policy-researchers-implementers/about-onc-health-it-certification-program

 

-Amanda Olson, DPT

Physical Therapy Documentation – Turning Attention to the Patient

Perhaps the most common thread across all physical therapists (PT) regardless of practice setting and specialty is that each of us became a PT with the intention of helping others. The process of deciding to become a physical therapist may have began at a young age (such is the case with myself at the tender age of ten years old), or perhaps for some this is a second career, but each one of us set out with the intention of participating and guiding people in healing and rehabilitation. The common thread of wanting to provide the highest level of care to our patients tends to drive us to continuing education courses, to certifications, and the most optimal practice settings. This hard work and attention to detail is reflected in the improvement of our patients. More importantly, and more concretely, this attention to detail is reflected in the thorough documentation of our treatment and plan of care.

Those of us who grew up without a cellular phone, laptop computer, or Netflix may have envisioned spending the working day one on one with patients, and quickly knocking out our written evaluations and SOAP notes before leaving at a reasonable hour each day. Or perhaps my ten year old vision of my future professional life was a little too rosy for my own good. As difficult as it can be to recognize, our ability to continue to practice in the manner we see fit is dictated by our ability to receive reimbursement for our work. In order to help others, our clinic’s lease must be paid and our lights must remain on.

Herein lies the struggle to maintain a healthy business in a phase of history where insurance requirements for reimbursement and Medicare laws are changing at the speed of light. We must reconcile the fact that there is no returning to a more simple time, and that reimbursement is most likely going to continue to become more complex. Thankfully, with every problem there comes an opportunity for growth.

Easy

Click the image to enlarge it and see the new bestPT Physical Therapy Documentation System.

 

A screenshot depicting the ease of Physical Therapy documentation by clicking through pre-programmed evaluation templates made unique for each Physical Therapy clinic. bestPT programmers are able to create unique specialty templates as well for various clinical specialties.

Several months ago our clinic underwent a significant change in how we document. Prior to this change we wrote daily SOAP notes in paper charts, and wrote initial evaluations and progress reports in PDF templates. We saw patients one on one for forty five minutes, and utilized an additional thirty minutes built into our clinical day for documentation. These initial evaluations and progress reports were typed into the PDF form and then printed by the therapist during designated charting times outside of patient treatment hours. Once printed these documents were manually faxed to the referring physician by front office staff. Prudent therapists know that medicare documentation as well as other third party payers mandate that documentation be completed within twenty four hours of patient contact. This expiration date made for a very long evening if a therapist experienced day with several evaluations and progress reports on the same day.

Once all staff members were trained in the use of bestPT electronic health record system, laptops were implemented by physical therapists to utilize for documenting during treatments. Returning to the initial rosy vision of altruistic patient care wherein we provide best services possible, there was initial worry by the staff that documenting into a computer in front of the patient would detract from building patient rapport. Some therapists worried that the time they spent documenting during treatment times would detract from actual treatment times. In reality once the system was put to the test, staff found that the easy clicking capabilities offered in the system expedited documentation time. Faster than manually writing in tests and measures, the electronic record allowed for concise documentation of all components of care from subjective report to plan of care.

Perhaps the most interesting finding throughout this transition has been patient response: there really wasn’t one. Patients were generally unphased by this transition because every other healthcare provider under the sun is already using electronic medical records. I asked a 65-year old Vietnam War veteran to Please pardon the computer as reviewed his prior medical history and he replied Oh honey you all do what you gotta do with those things, it don’t bother me none. A sweet gentleman to be sure, but truly we did not receive a single complaint during the initiation of the system.

PHI

Click the image to enlarge it and see the new bestPT Physical Therapy Documentation System.

Recording prior medical information is easy with the template. It is easy to return to this screen from others in the electronic medical record, and leads to easier continuation of care from one therapist to another as it offers a thorough and easy to read format.

Therapists now are able to complete an entire document as they treat for each and every patient. Upon completion of an initial evaluation the report is quickly sent to the physician for approval, eliminating several steps in our prior system. This has eliminated the need for additional paperwork time and actually freed up all of our schedules and allowed us each to see one additional patient per day with some remodeling of our scheduling template.

From a business perspective this has resulted of course in increased revenue. We are able to offer our services to more patients, and the turn around time on reimbursement is significantly decreased. We can all rest assured that we complete our paperwork on time, and indeed get home at a reasonable hour. This is how we have managed a win-win scenario in our clinic. We are able to provide the high quality services, still one on one, that we envisioned when we commenced physical therapy school, bright eyed and ready to heal the world. We are also able to maintain a healthy business without compromising or cutting corners. I believe that my ten year old self would be impressed.

-Amanda Olson, DPT