Posts

Fall, 2018: What Is “Defensible Documentation?”

What Is “Defensible Documentation?”

Hannah Mullaney

Defensible documentation in the physical therapy world — what does this entail? A paper chart donned with purple gloves, yellow gown, and p99 respiratory mask? Or maybe a sleek EMR (electronic medical record) laced with the defensive skills of a black belt extraordinaire. Actually, it harkens to the diligent PT typing notes over lunch, after work, and before patients arrive the next morning.
What is documentation? It is the thorough note that a physical therapist writes explaining what happened during an appointment. How was the patient? What happened during therapy? Why should insurance pay the therapist? It needs to be detailed enough to stand trial in a court case yet succinct enough for a single person to document 6-16 appointments in a day.
The American Physical Therapy Association (APTA) website faithfully reminds practicing PTs why documentation is so important.
Health care consumers trust physical therapists to use their expert training to improve, maintain, restore, and enhance movement, activity, and health for optimal functioning and quality of life. While safety and quality of care is most important when caring for patients and clients, documentation throughout the episode of care is a professional responsibility and a legal requirement. It is also a tool to help ensure safety and the provision of high-quality care and to support payment of services.
The national organization also provides tips and tricks for making high-quality documentation.
First of all, these are the skeleton of a solid physical therapy note, with a little sample of what each part means.
  • Examination – what the patient reports (subjective, “my hip hurts right in the crease for the last 2 months”), what the PT finds using tests and measures (objective, “limited range of motion of the left hip”), and systems review (“blood pressure is 110/70 and patient is oriented to self, date, place, situation”)
  • Evaluation – what the PT concludes from the examination
  • Diagnosis – Physical therapy diagnosis is different than a medical diagnosis. For example, if a patient tore their ACL, the PT would say, “Right knee ligamentous laxity” and the MD would say, “partially torn ACL.”
  • Prognosis – patient’s potential ability to regain function
  • Plan of Care – game plan!
Defensible documentation needs some muscles to give power to the treatment. This is the evidenced-based care. Tests, interventions, and exercises that scientific study has shown to be safe and effective encompass evidenced-based care.
The ligaments and fascia that holds defensible documentation together is the risk management component. If something was not written in the documentation, it is as if it didn’t happen. Therefore, PTs need to be careful to be safe in action and documentation in every single encounter– for the patient’s sake as well as their own.
Examples of risk management in note-writing include some of the following.
  • Confidentiality — HIPAA. Enough said.
  • Incident reporting – “Mrs. J’s blood pressure dropped to 90/70 during therapy.”
  • Maintaining patient records — filling out the daily notes and re-evals every time, keeping copies of insurance records, patient test results (X-rays, labs, MRIs, etc), exercise prescriptions, and the all-important consent form.
  • Electronic health record hygiene – maintaining safe passwords, keeping other patient’s information out of sight.
  • Fraud, abuse, and waste – only giving care to patients who need it.
Whew! That’s a lot for a physical therapist to keep in mind while they do dozens of these documentations a week. However tedious it can be, it is important for PTs to stay true and keep their documentation strong. It needs to ricochet against the possible legal encounters. It needs to be armed with risk management and evidence-based care. And the tool that houses all of this defensible documentation is the electronic medical record (EMR). A defensible EMR will follow the guidelines suggested by the APTA to keep patients and practitioners safe in the current age of medicine.
 

Welcome

New Members to the bestPT Network!

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

Let’s welcome bestPT Billing’s newest members!

Chelsea Dezelia Hadfield, Adam Walsh, Dalan Abreu, Deanna Armijo, Sara Balthaser, Nicholas Blonski, Zachary Blossom, Anthony Casazza, Anthony Chavez, William Chynoweth, Roberto Cordova, Kaitlynn Craig, Renee Dupre, Lucretia Duran, Joslynn Fletcher, Allison Foulk, Micaela Gilpin, Paige Goodwin, Morgan Kerschen, Charles Kettenring,Mikaela Lazar, Ashlee Lee, Ryann Montano, Hanna Park, Christian Pearson, Alexander Phillips, Francesca Picchi-Wilson,Jane Graham, Victoria Raught, Nicholas Romero, Alicia Roussin, Sam Sanders, James Schlavin, Tomas Tafoya, Nicholas Zarasua, Michael Alicto, Kori Apodaca Cordova, Tamaya Toulouse
University of New Mexico, Albuquerque, NM
Nicole Coddington, Blake Hebert, Speight McKenzie
Julie Tran
Kathryn Gerletti
Aleksandra Gutsman

 

Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

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 referring friend that is in our network, we’ll credit both you AND your friend’s account $50 a month.

 

Summer, 2018: Is Physical Therapy the Worst Kept Secret in HealthCare?

I still believe physical therapy is the WORST kept secret in healthcare. Last year I wrote a blog titled “Physical Therapy – The WORST Kept Secret in Healthcare” which allowed for some great discussion by the readers on the topic of physical therapy and where we fit into the healthcare system.   This blog post followed an open discussion called the “Chelan Chat” at the Washington State Private Practice Special Interest Group (PPSIG) spring conference at Lake Chelan, WA.  The ‘Chelan Chat’ is a twist on the Annual Graham Sessions hosted by the Institute of Private Practice Physical Therapy and was moderated by Steve Anderson. This year I was asked to present an “I believe” speech, that I would like to share with everyone here as a means to continue the discussion and a call to action. Here it goes…
I believe we are in the “story” business as physical therapists. We spend countless hours listening to patient stories, stories told by other therapists, stories told by doctors, stories told by friends and stories told by loved ones. We also tell a lot of stories too about weak muscles, weak cores and my favorite the infamous sacroiliac joint slippage! A vast majority of people fail to recognize the difference between a story and fact. In fact, most people view stories as facts and as Carnegie Mellon research shows, our stories carry far more weight than facts. In reality, a story is what we tell ourselves about the facts, it is not real. Our point of view is not the truth, it is our perspective. And perspective is based on our knowledge, previous beliefs, environment, the context or space we are in, our mood, our emotions, social pressures, and so on. Essentially our perspective is based on where we are at in life when we make up the story. I believe it is therefore important to remember that our perspective is just one angle on the facts, it is not the only story. Facts do not determine our point of view, our stories do.
So, I would like to invite you into my story on why I believe physical therapy is the WORST kept secret in healthcare.
Most of you are familiar with the common phrase “the best kept secret”. Being the best kept secret is great when you want to keep something a secret, such as your favorite coffee shop, restaurant or favorite place to vacation. However, when it comes to the role of physical therapy in healthcare, I believe that we are still a SECRET to a majority of consumers. This was highlighted in 2007 by Stephanie Carter and John Rizzo when they demonstrated that less than 7% of patients with musculoskeletal conditions utilize outpatient physical therapy services and again in 2012 in the Fritz and Childs study.
So, hopefully you are sitting there asking yourselves, why are we a secret? I believe we are the worst kept secret in healthcare for four main reasons:
  1. We have an identity crisis
  2. We suck at marketing
  3. We don’t know how to sell our product
  4. We are bullies to our brothers and sisters
Despite our shortcomings as a profession, I believe we are the BEST profession in a broken healthcare system and it is our time to move into the limelight.
 

Welcome

New Members to the bestPT Network!

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

Let’s welcome bestPT Billing’s newest members!

Jon Meyer
Asbury University, Wilmore, KY
Marissa Crouse
Jessica Lopez
Mary Ann Williams & Rani Patel
Caitlin Westlake
Erika Morales & Brandon Selvey
Alex Galewski
Fenn Chiropractic, Tallahassee, FL
Maddie Larsen & Robert Neise
Health Rehab Solutions, Kalispell, MY
Martha Cernicchiaro
Anna Barkins
Sheli Peterson
Physicians Vein Clinics, Sioux Falls, SD
Allison Enoch
Ventura Spine and Disc, Ventura, CA
Jeannie Hile, Ashley Astles, Francesca Foley, & Susan Leach
University of New Mexico, Albuquerque, NM

 

Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

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 referring friend that is in our network, we’ll credit both you AND your friend’s account $50 a month.

 

May 2018: Imposter Syndrome in Graduate Students

Imposter Syndrome: Dealing with Feelings of Self-Doubt and Inadequacy in a Doctorate Level Program

Imposter syndrome (IS): a collection of feelings of inadequacy that persist despite evident success. ‘Imposters’ suffer from chronic self-doubt and a sense of intellectual fraudulence that override any feelings of success or external proof of their competence.  Imposter syndrome is something we have heard about from professors, mentors, and advisors. They tell us that it is a normal experience for many graduate students, especially those in the field of healthcare. They tell us that this feeling may stick with us well into the first few years of our practice. While this is a well-known and widely experienced issue for many students of physical therapy, it feels anything but “normal.”

On any given day of any given week, I’ll turn to any fellow classmate and we’ll crack a joke about how underprepared we feel for our next exam, clinic session, or rotation. It seems it is a constant feeling of under-preparedness, or lack of readiness, that weighs heavily on our shoulders.  All this, despite the fact that we have made it well into our second year of didactics, and may even have a 4.0 GPA. We perform well in the classroom, but this does little to nothing to boost our confidence as proficient practitioners of physical therapy. How can we best deal with this feeling of inadequacy?

An article from Psychology Today discusses tips on how to handle IS, and even make the best of it. First, appreciate your position as a novice. Consider that your perspective is fresh, and that of an outsider, due to inexperience. Therefore, the questions you ask may be very original, since you have not yet bulked up on conventional wisdom.

Next, try to shift your mindset from one that focuses on performance, to a mindset that focuses on what you are learning. Realize that we learn the most when we make mistakes, so stop seeing mistakes as failures or inadequacies, and instead view them as opportunities to enrich your knowledge base.

The third tip is to realize that perspective holds a lot of power. You may perceive yourself as the only one in the room who is truly experiencing IS, or that you are the person least worthy to be in the room. In reality, it’s likely that the majority of people in the room share that perspective, or have at some point in time. Realize that you are not alone with this feeling, that this is common, and that this is normal.  This third tip feeds into my personal experience in dealing with IS. Positive perspective has helped me deal with IS thus far, and will continue to in the near future. I had never heard of the term “imposter syndrome” before grad school, even though I had experienced it personally from time to time in the past. Thankfully, as mentioned above, our faculty was quick to address the issue of IS early on, during our first year in the program. Hearing this coming from faculty, in a non-judgmental manner, was somewhat comforting. In a way, simply being made aware of IS from the get go made it a bit easier to accept, process, and handle moving forward in the program.

 

The Impostor Syndrome and How To Handle It. (n.d.). Retrieved March 28, 2018, from https://www.psychologytoday.com/blog/adaptation/201611/the-impostor-syndrome-and-how-handle-it

 


 
 

Welcome

New Members to the bestPT Network!

 

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

Let’s welcome bestPT Billing’s newest members!

Kathleen Wiemold
Korey Wiemold
Kellie Martin
Bassett Physical Therapy, Stanleytown, VA
Kenisha Dickerson
Melwood Rehabilitation, Upper Marlboro, MD

Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

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 referring friend that is in our network, we’ll credit both you AND your friend’s account $50 a month.

 

March 2018: Graded Imagery & Advanced Technology in the Treatment of a Patient Post-Stroke

Graded Imagery and Advanced Technology in the Treatment of a Patient Post-Stroke

Lisa Peterkin, SPT
 

With the advancement of technology comes the advancement of treatment tools that can be used in all areas of physical therapy.  Newer techniques used to treat patients after a cerebrovascular accident (CVA) have become more popular both in and out of the clinic setting to improve function.   

Traditionally, patients who have been affected by a stroke have been treated with Neurodevelopmental Treatment (NDT) techniques that include proper patient positioning and tactile cueing to progress the patient and improve their function.  Once the patient has improved strength, special awareness and normalized tone, they can begin to work with a physical therapist on more functional activities such as transfers and improved ambulation.

More frequently, now, physical therapists are including more advanced techniques such as Graded Motor Imagery (GMI) in their treatment of patients who have had a stroke.  GMI is thought to promote cortical brain activation and promote motor recovery after a stroke, specifically in the upper extremity. Within the category of Graded Motor Imagery are subgroups that include Explicit Motor Imagery (EMI), Implicit Motor Imagery (IMI) and Mirror Therapy (MT).  EMI uses the Kinesthetic and Visual Imagery Questionnaire (KVIQ), which includes 5 movements (shoulder flexion, finger tapping, trunk flexion, hip abduction, and ankle dorsiflexion) that are described to or demonstrated for the patient, then the patient is to imagine themselves performing the movement that was just described or demonstrated.  This Questionnaire is graded on a 5-point scale, from 0, where the patient was unable to imagine demonstrating that movement, to 5, where the patient could imagine it clearly. The next area of IMI incorporates Left/Right Hand Judgement, where the patient is shown 60 images of a hand in various positions, and the patient has to determine whether the picture is of a left or a right hand.  The last intervention is MT, where the patient is angled with their upper extremity next to a mirror so they have a clear view of the mirror with the reflection of their limb. The unaffected arm moves in various ways instructed by a physical therapist, and the illusion is perceived by the patient that their involved arm is moving.

The benefit of using these techniques is that they are simple to teach from one physical therapist to another, and easy for the patient to understand and be able to perform.  However, because patients who have suffered a stroke may have cognitive deficits, their lack of imaginary skills due to the CVA may influence the effectiveness of these techniques.

There have been many studies that assess the effectiveness of using more advanced technology with post-stroke patients.  The H2 robotic exoskeleton is used to improve gait in a post-stroke patient with hemiparesis who was able to walk only short distances at lower speeds.  The robot has 6 joints and focuses on improving an asymmetric, deviant hemiparetic leg during the stance phase of the gait cycle. It allows the patient to walk farther distances and have more stability in the affected leg while ambulating.  

Robot-Assisted Game Training has also been studied on its effectiveness with post-stroke patients.  Patients are given conventional therapy along with a secondary treatment that includes game training.  This includes a robotic arm that allows the patient to adduct and abduct the shoulder, and flex and extend the elbow of the involved arm.  By maneuvering the robotic arm, the patient can navigate through a gaming system on a computer and improve motor planning skills and cognition.  

While these techniques are still new and have minimal research, they open up a new world of treatment possibilities, especially in rural areas that are underserved with healthcare.  With these techniques and newer technology, patients may be able to return home sooner and have effective treatment sessions without going into a clinic, while continuing to show improvement in gross motor skills and cognitive function.

 

Bortole, M., Venkatakrishnan, A., Zhu, F., Moreno, J. C., Francisco, G. E., Pons, J. L., & Contreras-Vidal, J. L. (2015). The H2 robotic exoskeleton for gait rehabilitation after stroke: early findings from a clinical study. Journal of neuroengineering and rehabilitation, 12(1), 54.

Lee KW, Kim SB, Lee JH, Lee SJ, Kim JW.   Effect of Robot-Assisted Game Training on Upper Extremity Function in Stroke Patients.   Ann Rehabil Med. 2017 Aug;41(4):539-546.   https://doi.org/10.5535/arm.2017.41.4.539

Polli, A., Moseley, G. L., Gioia, E., Beames, T., Baba, A., Agostini, M., … Turolla, A. (2017). Graded motor imagery for patients with stroke: a non-randomized controlled trial of a new approach. European Journal of Physical and Rehabilitation Medicine, 53(1), 14–23. https://doi.org/10.23736/S1973-9087.16.04215-5

 

Welcome

New Members to the bestPT Network!

 

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

Let’s welcome bestPT Billing’s newest members!

 
Ehrum Khan   
PT Max, Philadelphia, PA 
Alicia Molloy
Jesslyn Scholl
Morgan Helser
Joshua Castro
PT Max, Philadelphia, PA
Katelyn Smitherman


Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

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!

 

Feb 2018: Avoiding PT Burn Out While In School

Mini-Clinics Help Prevent Student Burnout

Lisa Peterkin, SPT

We hear about burnout after a physical therapist begins practicing for a few years.  We also learn ways to prevent this from happening so that we remain interested and invested in our practices and in our patients  However, we never talk about burnout while in school.  After sitting in class, week after week, for 35+ hours, it can be mentally and physically taxing. It can be hard to still have that passion that we had when we first entered the program.  

In the Physical Therapy program at the University of New Mexico, we participate in weekly mini-clinics.  We go to various clinics, rehabilitation facilities, and hospitals throughout the city and surrounding areas for 4 hours each Wednesday morning.  We are partnered up with another student in our class and are assigned to a clinical instructor at the clinic we’re attending.  This is extremely beneficial because it allows us to practice newly learned skills while brainstorming together as we’re presented with newer conditions or techniques.

It’s also beneficial to be able to work with different physical therapists of different backgrounds, work experiences, ages, educations, and so much more.  It exposes us to a variety of styles and techniques, and we gain little tips and tricks on how to transfer larger patients, hand placements to improve reliability of special tests and ease when performing them, or how to have proper body mechanics for different body types.  These first-hand experiences also give us insight on what to prioritize when the physical therapist is running out of time with a patient during an evaluation or a follow- up treatment.  Many of the physical therapists I’ve worked under have a different flow while doing an evaluation, it’s helpful to see what works and to think about what I would do differently to come up with my own flow.

After every mini-clinic, we have a little reflection assignment due in our classes. We have a checklist of different things that we ideally would have seen in a morning at a clinic or hospital.  This includes things such as testing sensation, proprioception, range of motion, balance, etc.  It gives us an opportunity, once we’ve left the clinic, to reflect on everything we did, and why that was necessary for that patient. Occasionally, depending on the setting, we have the opportunity to work with, or alongside, other health care professionals, such as occupational therapists, speech and language pathologists, MDs, and nurses. We get to see how the physical therapist we are working under interacts with other health care professionals and see what role each of those people play in the patient’s overall health care.

While all these tips and tricks and times to practice are valuable and helpful, I personally believe the most valuable part is actually being able to work with real patients in a real clinical setting.  It breaks up the monotony of sitting in a classroom listening to lectures for 7-8 hours every day, and it gives us a chance to reignite the spark that made us all want to become physical therapists in the first place.  It gives us half a day of problem solving with complex patients, talking with patients about their goals with physical therapy, and allows us to see even minor improvements with patients within one treatment session.  Mini-clinics keep us interested and passionate about the profession when we start to feel burnout from being a student.  


Welcome

New Members to the bestPT Network!

 

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

Let’s welcome bestPT Billing’s newest members!

 
Sandre Allegre   
Sue McKeown
Asbury University, Wilmore, KY
Sara Beckley & Chris Poveromo
Thompson Physical Therapy.  Fresno, CA
Craig Brunson
Axiom PT & OT Plus,  Tuckahoe, NY
Betsy Harnden & Gervante Millender
Anne Moore & Deborah Doster
Integrated Mechanical Care, Sandy Springs, SC


Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

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!

 

Jan 2018: Importance of Developing Mentor-Mentee Relationships During PT School

The Importance of Developing Mentor-Mentee Relationships During PT School
Lisa Peterkin, SPT

At the University of New Mexico, Department of Physical Therapy, faculty, staff, and students all understand the rigor of the program and how much of an adjustment it can be to start a doctorate graduate program.  It doesn’t matter if the student came directly from undergrad, from a different graduate program, or took time off between prior schooling and PT school; there is always an adjustment period and a learning curve for any change.

We’ve developed a mentor-mentee program for all incoming students who are offered the opportunity to request having a mentor from the class above.  Both mentors (soon to be second year students) and mentees (incoming first year students) fill out a questionnaire about interests, hobbies, and schooling background, and based on the responses, we pair people who have similar interests and we feel will be able to connect outside of PT school.

Throughout the program, mentors are there to provide advice and support to their mentee, and to be another familiar face outside of their own classmates. In my personal experience, having a mentor made me less nervous about starting the program, and it gave me someone in the class above to look up to if I ever felt overly stressed or anxious about upcoming exams.  It was also somebody who I could ask about tips for classes, certain professors, or even exams and quizzes.

Mentors go beyond our student program.  Our professors are all mentors to us every day, both inside and outside the classroom.  They are always available to offer advice or answer questions via email, or if we’re lucky, we can catch them in their office when they’re not teaching or in clinic.  We have a strong and close bond with every professor in our program that make it easy to look up to them as role models and mentors, which, in turn, makes it easy to reach out whenever we need assistance in classes or advice on a patient we see in clinic.

In our student-led clinic, REACH, a handful of our professors participate as the licensed Physical Therapist when we see and treat patients.  They guide us when we’ve hit a roadblock or jump at an opportunity to teach us new techniques during an examination.  Based on their years of experience, they also offer new and creative exercises to use with our patients, or how to simplify an explanation for a patient.

We also form mentorships with our clinical instructors who guide us in a more practical and hands on way with patients in the clinic.  During my first rotation, my clinical instructor helped me to grow and improve my skills in physical therapy, but more importantly, she taught me how to think outside the box and to get creative with treatment ideas.  I always looked up to her and she was always there to offer advice or to encourage me to struggle on my own so that I could learn from my mistakes or work through a problem, which I always thought was even more valuable.

We are surrounded by mentors every day, even if we don’t necessarily realize it.  It helps us to grow as students, future physical therapists, and life-long learners.  We learn how to learn from other physical therapists’ and appreciate their styles and experience, and some of these mentors will continue to mentor us beyond our school years.


Welcome

New Members to the bestPT Network!

 

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

Let’s welcome bestPT Billing’s newest members!

 
Becky Staudt   
Jaidy Matos
Tammy Duncan & Savanna Booker
Kid’s Creek Therapy,  Suwanee, GA
Amanda Newman
Brooke McAdam
Jason Piken & Kristina Borza  


Everyone Benefits from bestPT’s

New Refer-A-Friend Program!

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!

 

Dec 2017 Newsletter: What to Expect When Starting PT School

December, 2017 Newsletter

What to Expect When Starting PT School

Lisa Peterkin, SPT

Everyone goes into their physical therapy program knowing that it’ll be hard work.  Knowing that they just spent the last 4 (probably a lot more) years preparing for admission and another 3 years of classes, studying, and exams. But no matter how much you prepare mentally and academically, you never really know what you’re getting yourself into.

Like many of my classmates, I took two years off in between graduating from college and starting graduate school. However, unlike many of those students, I continued to take classes during that period to complete any missing prerequisites.   I was still in student mode and in the studying mindset when I began graduate school.

As we prepared for our first real exam a month into our first semester, many students feared they had “forgotten how to study” and were very nervous about the quantity of information we needed to know.

Some people passed with flying colors while those who had “forgotten” their regular study habits received a loud wake up call that they would need to rediscover those old study habits in order to pass.  With the emphasis on quizes and exams during the first year, everyone needs to quickly “remember” how to diligently study.

Right before Thanksgiving break, we had our first heavy round of tests with 6 exams within two weeks. Everyone studied harder for our anatomy quizzes than we did for any final we had taken in college.

We looked at the second years, jealous that they were past the madness and stress of first year, wishing we could fast forward in time. And we continued to look at the second years in jealousy for the next 8 months. Little did we know, it wouldn’t get any easier.

After coming back from our first orthopedic rotation over the summer, we were excited
to enter a less demanding year.  We were also happy to be back in the city since most of us were in rural areas for our rotation.

Within the first week of classes,  though we quickly realized that it wasn’t going to be a cake walk, we were all still optimistic that it wasn’t possible to be worse than the stress and rigor we experience the year before.   As the projects and presentations began adding up in each class, it was soon clear that this semester would be far busier than first year. Instead of spending our Sunday’s frantically studying for the week ahead (or playing catch up from the previous week), we were sifting through Google Docs and Google Slides to figure out which presentation was a priority that day and when we needed to meet up with our group members to rehearse and review.

Now that we’re almost done with the first semester of second year and we’ve had
time to reflect while eating too much food during Thanksgiving break, many of us have
realized that this year has been just as hard as first year,  though in a different kind of way. I don’t go home and have a panic attack about how much studying I have to do or how many tests would be taking that following week.  My stress and anxiety is now from the number of presentations I have to give, despite my fear of public speaking , on top of studying for exams, being a tutor, and working in our service learning clinic every week.

Now, we all look to the third years, who are off on their rotations around the country
and are done with didactics, in envy and hope that one day we’ll make it to where they are. Past the seemingly never-ending sea of tests and projects of PT school.

 


 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!



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