Medicare‌ ‌Regulation,‌ ‌Documentation,‌ ‌and‌ ‌Finance

Medicare‌ ‌Regulation,‌ ‌Documentation,‌ ‌and‌ ‌Finance

Nick Blonksi, UNM DPT ’21

 

Medicare is a federal health insurance program that contains four parts (A-D) and is accessible for individuals that are 65 years or older, younger individuals with disabilities, and people with end-stage renal disease, and ALS.1 Each part of Medicare’s insurance plan provides different types of coverage for members. Part A covers “hospital insurance” meaning inpatient hospital stays, care in skilled nursing facilities, hospice care, and home healthcare agencies.1-2 Part B covers “medical insurance” meaning it covers outpatient care, medical supplies, some doctor services, and preventative services.1 Part C and Part D are both optional programs for Medicare member. Part C is considered an advatage plan and works by having the patients covered through a different company that Medicare pays, regulations are still through Medicare still.2 Part D covers prescription drugs for the patient.2 During the 2018 calander year 18% of the population in the United States was covered by Medicare.3 With nearly a fifth of the population having Medicare and other private payers following Medicare rules and regulations it is important for all health care providers to be confident navigating the world of Medicare. 

Home Health care is covered by Medicare and Medicaid and falls under Part A of Medicare coverage. To be covered for Home Health Care criteria must be met to prove that the patient is homebound. The two criteria are that they must have an inability to leave the home and if they tried to leave the home it would require a lot of effort and be taxing to accomplish.4 On top of these criteria they also need to be under the care of a physician and the plan of care must be approved by the physician. As physical therapists many roles are expected in a home health care environment. Physical therapists use an outcome measure called the “OASIS” to assess the patient on the initial evaluation. This outcome measure looks at the patient’s overall health through a systemic approach, while also looking at the patient’s functional abilities.4 In January of 2020 Patient-Driven Grouping Model (PDGM) became the new payment model for home health and aims to use clinical characteristics and patient information to put the patients into 432 case mix payment groups.5 The PDGM utilizes 30 day periods and requires an updated OASIS at 60 days or when there is a significant change in the patient’s status. The PDGM only is used for payment in the patient has visits that are above Low-Utilization Payment Adjustments (LUPA) for the specific patient case-mix group. If the patients number of visits are below the LUPA the visits are billed per-visit.5 All home health agencies also participate in quality assurance performance improvement (QAPI) that provides insurance companies, the state, and the agency itself to compare the agency to national norms and know what they are doing well and what they need to improve on.4 Other measures that are used in home health agencies to monitor their effectiveness, and outcomes are the CASPER, 5 star, and PEPPER tools.4

In an acute care inpatient setting the Center for Medicare and Medicaid Services (CMS) lists rehabilitation as an option service. For inpatient acute care hospital settings that do provide rehabilitation and follow the CMS regulation that before treatment a plan of care needs to be put in place that includes diagnosis, type, amount, frequency, and duration of rehabilitation services. It is also required in the plan of care to have the anticipated goals for the patient. In acute care patients are put into Diagnosis Related Groups (DRG), based on what DRG the patient is in Medicare part A will put together a bundled payment plan that is given to the hospital.6 However DRG alone do not make up the reimbursment given to the hospital. Reimbursment is calculated by using a case mix index (CMI) that takes into account the DRG and severity of the illness, while also considered the patients co-morbidities and the resources that are required to treat the patient.2 A patient with a higher weighted CMI the reimbursment will be higher that is given to the hospital to cover the patients stay. If however the patient develops a hospital born secondary condition, such as a pressure ulcer, no new money will be provided and the hospital will have to eat the extra cost if it exceeds the reimbursment given through the DRG and CMI. With the reimbursment the hospital then can provide whatever care is needed to the patient, this includes all the follow-up care given to that patient. Through the bundle payment model PT alone does not generate money for the hospital from services provided, however as a valuable member of the treatment team can help patients discharge faster, decrease readmission through proper discharge, and increase patient satisfaction. It also important to remember that it matters where the patient is seen within the hospital as emergency rooms, and observational status patients are billed as outpatient and fall under Medicare Part B coverage.7 

Inpatient rehabilitation facilities (IRF) also follow along with acute care in having a predetermined payment amount through a bundle payment. This is determined by grouping patient cases into rehabilitation impairment categories, based off of diagnoses. Once in these groups patients are further grouped into cognition and functional groups and comorbidities are considered to place patients into four tiers.8 Based on what tier the patient is in the payment for that case increases or decreases. Other criteria considered for reimbursement is geographical wages, number of low income patients seen, and if there is resident training at the facility. IRFs also have to have 60% of their patients fall under 13 categories of diagnoses ranging from strokes and other significant neurological conditions to fractures of the femur.8 

In IRF the patient’s individualized plan of care must be completed by a physician with involvement from all team members that are part of the patients care team. The plan of care needs to be completed within 4 days of admission. IRF also requires the care team to have an initial team meeting within one week of admission and most meetings then occur weekly throughout the length of stay.8 Within IRF physicians are required to order all therapy services. For physical therapists the CARE tool is used to help support documentation and show the patient’s need for intensive rehabilitation by scoring the patient’s functional abilities on 17 functional activities. The Care Tool can be completed over a 3 day period at admission and at discharge for the patient.8 Group therapy services can be provided to the patient along with concurrent therapy when the therapist finds this appropriate. Regulations in IRF for group therapies are no more than 4 patients to 1 PT or 1 PTA at a time, and all the patients need to be doing the same exercises. Also patients should have no more than 25% of the patients therapy sessions can be group therapy.9

Outpatient physical therapy can fall under two different structural models. If the outpatient clinic is hospital affiliated it is considered a comprehensive outpatient rehabilitation facility (CORF) and requires a physician referral.9 The other model is a Private PT clinic that does not require a physician referral for Medicare. For both outpatient models Medicare pays through Part B and both require a certified POC.10 Outpatient clinics are paid by the services they provide through relative value units (RVUs) for the time spent on different current procedual codes (CPT) that outline different types of treatment interventions. Because of this outpatient clinics require the direct supervision of PTAs and eliminate the ability to bill for student lead services as they are not skilled.9 As an outpatient physical therapy clinic a plan of care must be written by the physical therapist and signed by a physician within 30 days of the initial evaluation to be certified with Medicare.10 The POC that is written must contain a PT diagnosis, long term treatment goals, type of treatment, amount, frequency and duration of PT services. The certified POC is valid for 90 days from evaluation unless the POC needs to be modified. Once either condition is met a new POC needs to be recertified.10 Within a POC a progress report is written to provide justification for treatment every 10th visit by the physical therapist. Lastly, Medicare requires a daily treatment note to be written to provide evidence of skilled treatment.10 For each patient a therapy cap of $2040 is alotted for the combination of PT and speech therapy services over a year. If a patient requires more service then is possible under $2040 justification is required from the therapist to show the medical necessity.

Overall physical therapy is typically covered through either Part A or Part B of Medicare. Home healthcare agencies, IRF, and skilled nursing facilities all fall under Part A of Medicare and are paid through a bundle payment that is based on the patients diagnosis, comorbidities, and functional impairments.9 This differs slightly from Inpatient Acute Care Hospitals, even though they fall under Part A, since only the diagnosis & comorbidities are considered for the bundle payment.9 CORF and Private PT Outpatient are covered by Part B of Medicare and are paided for by the services that are provided to the patient. Outpatient clinics have extra regulations to ensure that the services being provided are skilled. One is that supervision of PTAs needs to be direct instead of general like all other settings, and another is the inability to bill for services provided by PT techs and students.9-10 Medicare regulations, documentation, and billing are important to understand as they set the bar for insurances and account for nearly one fifth of insurance coverage in the United States.3

References:

1. “What’s Medicare?” Medicare, www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medicare. Retrieved 06/21/2020

2. Vallejo, Rose. “Insurance 101 & Introduction to Medicare.” PT 680-Administration and Supervision for Physical Therapists. PT 680-Administration and Supervision for Physical Therapists, 1 May 2020, Albuquerque, University of New Mexico Division of Physical Therapy.

3. “MDCR ENROLL AB 2 Total Medicare Enrollment: Total, Original Medicare, and Medicare Advantage and Other Health Plan Enrollment and Resident Population, by Area of Residence, Calendar Year 2018.” Centers for Medicare & Medicaid Services, www.cms.gov/files/document/2018-mdcr-enroll-ab-2.pdf. Retrieved 06/21/2020

4. Hastings, Lucas. “Home Health: Implications for the PT.” PT 680-Administration and Supervision for Physical Therapists. PT 680-Administration and Supervision for Physical Therapists, 9 June 2020, Albuquerque, University of New Mexico Division of Physical Therapy.

 5. “Centers for Medicare & Medicaid Services Patient-Driven Groupings Model.” Centers for Medicare & Medicaid Services, Abt Associates, www.cms.gov/Medicare/Medicare-Fee-for-Service-payment/HomeHealthPPS/Downloads/Overview-of-the-Patient-Driven-Groupings-Model.pdf. Retrieved 06/21/2020

6. “DRG Classifications and Software.” Centers for Medicare & Medicaid Services, 5 Nov. 2020, 6:09 PM, www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software. Retrieved 06/21/2020

7. Jarnagin, Forest. “Regulatory Issues in Acute Care and Supervision and Leadership .” PT 680-Administration and Supervision for Physical Therapists. PT 680-Administration and Supervision for Physical Therapists, 16 June 2020, Albuquerque, University of New Mexico Division of Physical Therapy.

8. Vallejo, Rose. “Inpatient Rehabilitation Facility (IRF) Medicare Regulation” PT 680-Administration and Supervision for Physical Therapists. PT 680-Administration and Supervision for Physical Therapists, 11 June 2020, Albuquerque, University of New Mexico Division of Physical Therapy.

9. Vallejo, Rose. “Outpatient Physical Therapy Private Practice Clinic Park B.” PT 680-Administration and Supervision for Physical Therapists. PT 680-Administration and Supervision for Physical Therapists, 18 June 2020, Albuquerque, University of New Mexico Division of Physical Therapy.

10. Vallejo, Rose. “Medicare – Part B Documentation.” PT 680-Administration and Supervision for Physical Therapists. PT 680-Administration and Supervision for Physical Therapists, 18 June 2020, Albuquerque, University of New Mexico Division of Physical Therapy.

Telehealth during Covid- from a patient’s perspective.

Telehealth during Covid- from a patient’s perspective.

Nick Blonski, UNM DPT, ’21

Over the past four months or so I have had the opportunity to see healthcare during the COVID-19 era from the perspective of a patient. This has allowed me to personally feel how the changes we have made to keep providing patient care during a global pandemic have impacted our patients. This opportunity has allowed me the chance to see the good and the bad of telehealth and social distanced health care. To begin I want to start by saying all the health care providers I have worked with have been wonderful and are all phenomenal providers, and second this is only my perspective and is not meant as a fully encompassed view of the current state of health care.

I wanted to start by stating how weird it is to go into potentially life changing appointments while sitting at home and staring at a computer waiting for the doctor in the virtual waiting room. The setup just feels a bit odd, one minute you are sitting there drinking your morning coffee in your PJ pants and then all of a sudden you are in a deep virtual conversation with a provider about information that changes the trajectory of your day to day life. Before you know it the zoom, or google chat room closes and you are left sitting there trying to process the news in your living room. The good news is many doctors have understood this concept and are willing to sit in the virtual chat and discuss details for as long as you need, however the difficulty with this is that there is always an abrupt ending to the call and the patient is still left sitting there with their mind racing and the urge to google what they were just told. One thing I have found that has helped is that when a doctor gives life changing information many of them have allowed me the opportunity to schedule an in person visit after the virtual call to follow-up and do the physical examination. 

Another area that has been interesting to see is that there seems to be no set appointment length with patients during this time. My experience has been that my virtual appointments last anywhere between 6-45 minutes. This has been an adjustment as a patient because many times you go into physical appointments and can expect to be seen for around 20-30 minutes. My best virtual appointments have been with the doctors that take the time that would normally have been filled with physical examination and discussed research and things to try at home and scheduling in person visits as necessary. My less effective virtual appointments were doctors just telling me physical lab results that have already been uploaded to my patient portal and ending the call with no clear conclusion. As many professionals try to navigate this new era of health care one area that can not be lost is bedside manners.

One area that I have enjoyed about being a patient in this time is that it has expanded the network of clinicians I can see. I was able to see my PCP back in Minnesota, while still going to school in New Mexico and then within the same week see a specialist down in New Mexico. This type of care has allowed for a wider variety and a larger network of providers to work together. It makes it feel almost like you have your own personal pick of providers as long as they are covered by your personal insurance. This makes getting second opinions easier and more efficient than before. 

Telehealth has provided many challenges for providers to work through on their end, but one area that can not be forgotten is the patient’s experience. The struggle of having to log into a virtual chat to hear news that could alter an individual’s whole life and having that chat end leaving them sitting in their living room is unprecedented for many individuals. Having had the opportunity to live this reality has made me recognize the struggle our patients are going through. The lack of face to face interaction has taken a piece of the compassion out of a professional field that strives to provide our patients what they need during major life changes. This isn’t to bash on telehealth. I have actually thoroughly enjoyed being able to utilize telehealth as a patient, it is just to remind ourselves that our bedside manners are even more important when social distance creates barriers to the compassion that many of our patients need. Through our own continuing education and experiences I think telehealth can become an important piece of health care going forward. 

A message from the President of Billing Dynamix:

Safety and Prepareness Statement Regarding Coronavirus diseases (COVID-19) The purpose of this message is to inform you about our Business Continuity Plan in the face of a growing threat by COVID-19 pandemic and the related regulations, which could pose a significant business disruption. Worse, some payers are already taking advantage of the situation to keep…

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!