Physical Therapy Billing | SWAT Team

SWAT physical therapy billing teamBy Jason Barnes, COO

We are proud to introduce our new physical therapy billing SWAT team!  They are tasked with solving large-scale and complex physical therapy billing problems that fall beyond the expertise of your account manager and billing team. This new addition to our team packs over 50 years of physical therapy billing, practice management, and Vericle experience. It is managed by Kathleen Casbarro and it includes Wendy Thorington and Rebecca Harwood.  

The SWAT team works with your account managers, the physical therapy billing follow up team, and technology team focusing on large-scale problems. Your account manager, PMC, SPOC or Coach uses their judgment when deciding to activate the physical therapy Billing SWAT team for your account. But you should know that your SWAT TEAM is constantly looking for ways to improve the reimbursements you receive.

Their expertise includes:

  • Vericle® system knowledge
  • Trouble-shooting complex physical therapy billing issues
  • Rate validations
  • Practice management coaching

The Network Effect,  an example of a case recently resolved by our new physical therapy Billing SWAT team is shown below. This Practice joined the bestPT Team in July and was fully trained in the system between September and October.  In Late December the bestPT Team and the practice agreed that there was a serious concern with one of the payers for the provider.The bestPT team activated the SWAT Team. One month later the issue has been resolved which resulted in almost doubled the billable income!  In another 30 days the SWAT Team was so effective that they had increased the billable income by an additional 300 percent!

Your SWAT Team

Kathleen, brings 28 years experience in Practice Management with specialty background in Cardiology, Orthopedics, Mental Health, Nephrology and Durable Medical Equipment (DME) coding and billing. Kathy has held a coding certification from the American Academy of Professional Coders (AAPC) for 11 years,  and brings 6 years – in Vericle, including major accounts across both ambulatory practices and hospital facilities.  Kathy has owned and operated two successful turnkey DME businesses and shares her knowledge and business sense with the clients in Vericle.  Kathy has been instrumental in our needs assessment to building a UB-04 billing platform. In the next 3 months she will be performing a needs assessment for implementation to ICD-10.

Wendy brings 5 years experience of Vericle, Coding certification, and 21 years experience in Practice Management with a specialty background in Chiropractic, Cardiology, Physical Therapy, Pediatrics, Optical, and Home Health.  Wendy excels in identifying billing patterns, processing errors and/or system issues that inhabit the final adjudication of claims. Wendy continues to implement new billing validations as payers dictate their billing policies.  Wendy is currently doing a portion of quality assurance on claims processed by the billing follow up team on a daily basis.  

Rebecca has 2 years Vericle experience coupled with 2 years experience as a Project Manager, focusing on implementing a new documentation platform used by our Physical Therapists with attention to the most current tests and treatments. Rebecca is also managing our latest implementation of XDocs, which is a customized documentation program that stores and tracks arbitrary forms. Rebecca is currently working with practices to customize templates based on the documents they provide. The XDocs can be shared among practices and Rebecca is working on developing templates that will be made available to all practices. Rebecca has a Bachelor of Arts in Psychology.

Physical Therapy Billing | Would you pay for your services?

Physical Therapy Profitability: Jack-LalannePhysical therapy profitability really depends to a great extent on how much your patients value and like your services.Harvey Schmiedeke, President of Survival Strategies and author of Keys to Private Practice Success used to have a client in a northern US border area (p. 134). “Canada as you know has socialized healthcare, supposedly offering everything for free. The large majority of his client’s patients were Canadians. They would go through the hassle of clearing customs and drive hours to pay him $78 US cash for treatment they supposedly could get for free in their own country. Why? Because he had the reputation of handling headaches and they knew if they went to him they’d be seen immediately and they’d get better!”

In every industry, regardless of geography, referrals, word of mouth are the strongest and most valuable source of customers and patients.

What services could you offer to:

  1. differentiate and elevate your physical therapy practice above the competition?
  2. attract highly motivated and loyal patients?
  3. cause patients to rave about your services to their friends and families?
  4. add significant revenue to your pt practice?

For instance, can you offer any one or a combination of these products:

  1. Equipment, supplies, or supplements
  2. Massage
  3. Wellness and Fitness Program
  4. Sports Enhancements Program
  5. Injury Prevention and Ergonomic Re-Design
  6. Vestibular Balance Program
  7. Weight loss Program

What are the steps to discover or invent a program that would really work in your area while increasing the profitability of your physical therapy practice?

Some coaches and practice management consultants suggest surveys are effective means of discovery– but do they really work?

I doubt Harvey’s client surveyed his Canadian neighbors prior to offering his headache handling services. Ford’s notorious quote is: “If I asked my clients what they want, they would ask for a faster horse.” Steve Jobs too is famous for NOT doing any surveys and trusting his intuition.

Apple Computer president Michael Scott in 1980 wrote a memo announcing that “EFFECTIVE IMMEDIATELY!! NO MORE TYPEWRITERS ARE TO BE PURCHASED, LEASED, etc., etc.” by the computer company, with a goal to eliminate typewriters by 1 January 1981.

In 1988, Microsoft manager Paul Maritz sent Brian Valentine, test manager for Microsoft LAN Manager, an email titled “Eating our own Dogfood”, challenging him to increase internal usage of the company’s product. The idea behind “dogfooding” is that if you expect customers to buy your products, you should also be willing to use them. Some people call this “do what you preach.”

Dogfooding needs to be transparent and honest: “watered-down examples, such as auto dealers’ policy of making salespeople drive the brands they sell, or Coca-Cola allowing no Pepsi products in corporate offices … are irrelevant.” (Wikipedia) A perceived advantage beyond marketing is that it should allow employees to test the products in real, complex scenarios, and it gives management pre-launch a sense of progress as the product is being used in practice.

“Microsoft’s use of Windows and .NET would be irrelevant except for one thing: Its software project leads and on-line services managers do have the freedom to choose.”

If you think about it, patients, like customers, seldom know what they really need or want. Surveys only help those who sell survey management services.

When it comes to your physical therapy billing and profitability, you and your staff need to be the final judge of your services. Steve Jobs wanted a computer that he would want to use instead of the typewriter. Ford wanted a car that he would want to drive instead of riding a horse. I want a software service that my staff and I would WANT to use to manage our company.  I want a blog that I choose to read it, that would teach me something new.

Think about it – if you cannot use it, why would anybody else want to use it? If you offered an weight loss program while you weighed 250 pounds, do you think you would attract any patients?

On the other hand, if your program was that good that you used it yourself, how easy would it be to tell your story and get paid for the your services? Would it really matter if insurance covered it?

Trust your intuition and you will have happy patients who tell their friends about your physical therapy services!

Physical Therapy Profitability | Staff Compensation Strategies – Part III

incentives for physical therapy practice employeesHow to Select the Right Incentives to Improve Your Bottom Line

By Yuval Lirov, PhD, Dave Macolino, and Kevin McGovern, DPT

“So, why don’t we move all of my staff on commission?” asked Peter.

“That’s the right business approach,” responded Alicia, “except most people do not have self-confidence and productivity to work on pure commission. For instance, would your biller agree to work on 100% commission of your insurance collections? Most likely, she wouldn’t, because she needs to pay her mortgage and other fixed costs and she cannot make her income dependent on your patient flow and the insurance companies. She expects a steady check regardless of your revenue, which depends on her performance. Actually, do you have ways to measure her performance? If you discovered under-performance, what would you do?”

“Today, I pay her regardless of her or my practice performance. That’s not a healthy relationship,” lamented Peter, “It’s hurting the business.”

“The good news is that, like Katherine’s office, there are companies that work on commission-only arrangement,” said Alicia, “outsourcing your physical therapy billing would make more sense because a specialized billing company would have processes to manage their employee performance, including correct incentive methods. Actually, if you talk to an outsourcing company, always ask them how do they compensate their employees? Are they all on commission? If not, then you will end up with the same problem with even less control.”

“Actually, no matter how big or small my physical therapy practice is, all of its parts must work together to succeed. If administrative staff allows too many cancellations and doesn’t help with referrals, patient visits will suffer and the revenue will decline,” said Peter.

“A Pay- for-Performance pay scale rewards the staff who produce and penalizes those who don’t. As a practice owner, I am always on Pay-for-Performance pay scale. You pay yourself less when the company’s revenue is down. Why shouldn’t the staff’s income be on the same path? Tomorrow, I will change my compensation setup for my employees,” Peter sounded really excited.

“Slow down, Peter,” said Alicia. “Before you make any changes, review them with a Human Resource and Compliance specialist to get sound advice,” warned Alicia. “We don’t need a lawsuit because we missed a legal requirement to make the changes we want.”

What do you think? Is Alicia right in her reasoning?

Do you know of a PT-specific staffing system that could make Alicia’s and Peter’s dreams come true?

Physical Therapy Patient Care | New Milon Exercise Equipment

Physical Therapy equipment: Milon Circuit

By Steve Messineo

How New Milon Exercise Equipment Will Help Your Patients with Long Term Wellness and Increase Your Practice Revenues

In June of 2012 I met the President of Milon USA, a company promoting a line of circuit training equipment that has become extremely popular in European health clubs and physical therapy clinics. Milon is a German company that recently decided to test the vast US Health Club Market. What they did not expect was the opportunity to bring their product to a facility that houses both a physical therapy clinic and a fitness center.
So, after some education and negotiation, my business partner and I decided to bring Milon into our facility. You may be asking what is so wonderful about this circuit training equipment as compared to the various American-made lines.

Here are several features to the Milon exercise equipment that made it attractive to us and should be attractive to all physical therapy clinics that have 600 square feet of extra space to put this circuit in:
1) The equipment is easy for everyone to use. There are no weight settings – the resistance is provided electronically against both concentric and eccentric muscle contraction. This allows for a much more efficient workout and eccentric loading of muscles has been known to accelerate rehab from numerous conditions.

2) The resistance increments are offered at 2 pounds and resistance protocols are entered on a touch screen on each machine. Furthermore, because there are no weights, patients will not feel self-conscious about their resistance settings because no one else in the circuit will know what they are doing.

3) The machines automatically adjust to the user’s height and position after the initial set-up using a memory chip on a smart card – no more pulling knobs to adjust seat heights. This further increases the ease of use of the equipment making it perfect for PT patients.

4) The entire circuit takes less than 20 minutes to do but allows the user to get a fantastic workout. Patients who claim they don’t have time to exercise have no excuses if your clinic has a Milon circuit.

5) All of the equipment is attached to a computer that automatically documents a user’s progress. We can use that objective information in our reports to physicians and insurance companies documenting patient progress.

6) Finally, and most importantly, the addition of this equipment is going to create a long term revenue stream for our business as patients transition into long term exercise maintenance programs using the Milon equipment after they have been discharged. This increases customer retention and creates revenue via membership use of the equipment. We are projected to make an additional $20,000 in net revenue after the first year as a result of Milon implementation and this figure is conservative at best.

Anyways, I could go on and on about all of the fantastic benefits Milon offers both patients and physical therapy practice owners, but that would make this article extremely long. So, if you would like to learn more, email me at smessineo@allaccessfa.com and I will be happy to provide you with more information. Or you can visit www.allaccessfa.com/milon.

Physical Therapy Profitability | Staff Compensation Strategies – Part II

physical therapy staff compensationBy Yuval Lirov, PhD, Dave Macolino, and Kevin McGovern, DPT

 

Peter went to college with Katherine. They graduated together and were good friends. Katherine opened her physical therapy practice four years ago and was in the process of opening her fourth location. She was averaging 800 patient visits a week.  

 

“We didn’t speak for long because she was about to take her golfing lesson but in the few minutes we spoke, I thought of an idea,” said Alicia.
“I couldn’t even consider taking a day off to golf,” thought Peter to himself. “OK Alicia, what did you come up with?” Peter relented.  

 

“You know, she pays her physical therapy practice staff based on performance. Let’s start with some facts. Employee salaries vary in three ways: type of service, years of experience, and location. For instance you can see in (“2011 Staff Salary Survey” Physicians Practice):

 2 Years Experience – South East 20 Years Experience – North East
 Front Desk Staff $22,147 $41,147
 PTA $45,243 $72,165
 Billing Staff $26,995 $42,625

 

There are four kinds of basic staff compensation: hourly, monthly, base salary plus performance bonus, and profit sharing or pure commission,” said Alicia, handing the table to Peter. “Employee compensation is a cost of doing business. If you had no employees, you would eliminate that cost but if you spend time greeting patients and chasing insurance claims, you have no time to treat patient and manage referral relationships. So to grow, you need help.”

 

“So, you hire staff to treat patients, to greet them and schedule their visits, and to chase insurance payments. The problem is motivation. Can you tell me what are the costs of unmotivated front office staff?”

 

“Well, Alicia,” said Peter, “A careless front office person might get patients upset, forget to collect co-pays, not follow up on a missed appointment. They could also get other office staff upset because they would not work together as a team. The cost of unmotivated front office person in terms of physical therapy profitability could be increased patient attrition, impact cash-flow, and the bottom line ultimately. The cost of an unmotivated hire is much more expensive than a few more dollars per hour…”

 

“So, Alicia,” Peter sparked up in spite of the late hour, “Should we look for more qualified front office staff and pay $15, or maybe, $18 per hour?”

 

“Not so fast.” said Alicia. “If you pay more per hour, you will reduce turnover because fewer practices around will compete with your compensation, but you will still have the same motivation problems, regardless if you pay $12 or $20 per hour. Tell me, what’s the problem with paying hourly wages to staff that needs people interaction skills? What is the ultimate goal that your font office staff must meet?”

 

“I get it now!” Peter didn’t notice his voice rising. “The physical therapy front office staff is responsible for patient loyalty and referrals. Working with people requires attention to detail and interest in their problems. Especially when you work with injured or sick people. It’s hard work, people feel burnt out.  So, compensation and incentives must acknowledge their results, such as new referrals, fewer missed appointments, fewer missed co-pays. I could structure the front office salary so that they get minimal pay for standard work and a percentage of collections to give them incentive to grow referrals and keep patients compliant with their plan of care.  Since more referrals, fewer missed appointments, efficient collection of cop-pays and balances increases collections, they could work more and make more than the best paid staff around!

 

“Right,” said Alicia, “and not every person will be ready for this kind of compensation. But that’s OK too: why waste time hiring a wrong person for the job and then discovering that they lack the skills and motivation to do the hard work?”

 

“So, what about the PTA? Should I also pay him a bonus? but for what?” asked Peter.

 

“Sure, you do not want to pay him for idle hours during no-shows, and you do want to pay him proportionally to the number of patients he sees and for better plans of care. That’s called profit sharing,” said Alicia.

 

“…or commission,” continued Peter her thought. “OK, I get it – commission and bonus helps people focus on the result of their work and not on its difficulty. The compensation structure helps motivating my staff and improve teamwork, avoiding problems and contributing more to my bottom line.”

 

“So, why don’t we move all of my staff on commission?” asked Peter.

To be continued.

Physical Therapy Billing | Track claims to improve cash flow

physical therapy billing payment performance“With bestPT I can track claims by payer or by patient. I can track by almost anything you can think of.”

– Dr. Kevin McGovern, DPT, McGovern Physical Therapy Associates

North Shore, Massachusetts

 

My name is Dr. Kevin McGovern. I’m a physical therapist and strength and conditioning coach. I own McGovern Physical Therapy Associates. We have four locations in the North Shore of Massachusetts, we have 35 employees. We are averaging about 725 visits, and we’ve been in business since March 15 of 2000.

 

You know my goals are to certainly make an efficient physical therapy practice where people want to come to work at and certainly improve my cash flow. Where we have the most difficulty in terms of Physical Therapy Billing is with the liability insurance companies, motor vehicle, workers’ comp. Since going to bestPT, who is now billing stuff electronically, I got an automobile check within fifteen days, which is like winning the lottery. I have never seen that in ten years of practice.
Well we had an archaic system before. We had many different Physical Therapy Billing systems blending into one that allegedly talked to one an other, but sometime that didn’t always happen, and the tracking of a claim was next to impossible.

 

With BestPT Physical Therapy Billing Software I can track claims by payer, I can track them by patient, I can track them by almost anything you can think of. So being able to go in and see problems even before they’re happening, or you can see it getting to a point where we may want to check on this, is invaluable. As we have been working together, the problems with Physical Therapy Billing claims have been severely diminishing, so most of them have been going out. Our cash flow is up $10,000 a week, so something is going right.

Physical Therapy Profitability | Staff Compensation Strategies – Part I

physical therapist billing strategyBy Yuval Lirov, PhD, Dave Macolino, and Kevin McGovern, DPT

“It’s ten minutes past eleven at night…Where is Peter?” Alicia asked herself as she woke up from dozing in front of the TV with their daughter, Jessica. She was pleased to hear the sounds of an unlocking door and Peter walking in. He looked exhausted but was happy to carry Jessica to bed. After all, it was a Saturday and he should have had the day off.

Alicia was proud or her husband. He worked tirelessly without counting hours, evenings and weekends, so that he could accomplish his goal of owning his own physical therapy practice and give Alicia the freedom to dedicate herself to raising their two children and continue pursuing her MBA.

Peter opened his physical therapy practice two years ago and built his business from the ground up. Referrals were growing rapidly and he was now seeing 100 patient visits per week. He recently hired a PTA in addition to his administrative staff to help him with his growing case load. His passion was treating patients but his current priority was building his practice and achieve physical therapy profitability. Peter was telling Alicia that in a year or two, he could pull in more than $600,000 a year, perhaps making $6,000,000 over ten years.

“Pete, Jessica was really upset that you missed her soccer game again. All of the other Dads were there.” Alicia said disapprovingly. Peter worked every evening and weekend over the past 3 months. “I don’t understand why you spend every night and weekend in the office,” she said. “Isn’t your staff supposed to be doing most of this work while you are treating? Do they stay late to help you?” she asked.

“I really don’t need this extra stress right now,” he replied. “I can’t pay them overtime to help, and I really can’t sit there and watch what they’re doing all day.”

“You know, Peter,” pressed on Alicia, “It’s clear to me that you’re not managing your staff properly.”

Peter felt like he was punched in the stomach. He wasn’t going to challenge Alicia. For the past two years, she managed to take care of Jessica while pursuing her MBA. Peter started getting a headache.

“You are heads down all day treating patients and not paying attention to what is going on with your staff.” she added. “Last month, you had to replace both your front office person and two months ago, you replaced your biller.”

“You’re paying your administrative staff $12 and hour and you just hired a PTA for $45,000 a year but you’re doing most of the work anyway.” Alicia continued, getting more agitated. “You have to be losing money because of the turnover and salaries and on top of that, you’re never home anymore. If you are going to see 100 patients a week and then spend every night and weekend doing business administration, why have staff at all?” Alicia asked.

“Good question, I don’t know” Peter reluctantly replied.

“Katherine called the other day.” Alicia said.

** to be continued :  Physical Therapy Profitability | Staff Compensation Strategies – Part II

Physical Therapy Practice Profitability | Real Cost of EMR

Calculate physical therapy practice profitability by discovering the real cost of documentation and EMR.

“The real problem is that even with a 20-minute SOAP note, I need a tremendous amount of time just for documentation. Peter wearily continued, “If I had 4,000 visits a year, I could make $312,000 a year. But even with the best documentation system I would need an hour to document 3 visits. That’s 1,333 hours a year just for documentation!”

“Wait a minute, Peter,” Alicia said, raising her voice. “those 1,333 hours ARE the evenings and weekends you miss with your family. When you see patients, your average revenue is $156 per hour. But when you document their visits you make zero, nada, zilch! Peter I think our mistake is that you only focus on increasing the number of patients you see. I understand you must invest time for documentation compliance. But we should find a way to reduce that unproductive time which pays you nothing.

“I do understand your rational Alicia, but the best documentation system only gets us down to 20 minutes per note. That’s still a problem. It places us in a dilemma to either spend 1,333 hours documenting or see fewer patients and lose revenue. What should we do?”

“Peter, let’s first figure out the REAL cost of your current documentation system. Alicia continued, “Let’s see if the computerized documentation system is better. Then we can think about our next step. Does it sound like a plan?” Peter relented and agreed with Alicia.

“So, if your average revenue for patient care only is $156 per hour, then that’s the best you can do. Every other activity dilutes the revenue. Now lets estimate the COST of other activities in terms of the best value you could be getting by seeing the patients. Does that make sense Peter?”

“First, let’s see how long it takes you to write an average note with your current system. An hour? So you see Peter, you are spending that time writing a note instead of seeing a patient for $158 per hour. How many notes do you write per year? 2,000? OK, then your current manual documentation system costs you $316,000 every year. Do you care to know how much that is in 10 years? Right! Three million, one hundred and sixty thousand dollars . . . That’s a very expensive compliance requirement, would you agree Peter?”

“Next, let’s estimate the documentation cost of your 20 minute notes. One 20 minute note will cost you a third of your best performance revenue, or $52. If you multiply $52 by your total annual visits, which is 2,000, that’s $104,000 in annual documentation costs. Care to extrapolate that into a decade? That would be over One Million and forty thousand dollars. That’s better than three million but still VERY expensive.”

“So, what can we do? Where can we find a documentation system that costs less?” Peter sounded discouraged as he felt his rosy plans being crushed by the cold hard facts of Alicia’s reasoning.

“Well Peter,” said Alicia, relieved that she was able to get Peter to finally think about the business side of his practice, “We must find a documentation system that does not take more than 3 to 5 minutes for a single note. Just imagine, if we had a system that took 5 minutes per note, you could do 12 notes an hour. In other words, your per note cots would be “only” $13 per note. Therefore, documentation of your entire year would cost you $26,000, or $260,000 over a decade.” chimed Alicia. “Now that’s a cost we can live with!” exclaimed Peter.

“And in terms of hours,” added Alicia, unable to hold her excitement, “you would only need 167 hours to spend on visit documentation for entire year. That’s just a tad over 3 hours extra a week! Imagine being able to work almost regular hours and still see 2,000 patients a week.”

“So, Peter,” concluded Alicia, “until we find such a system, you have to choose between your family and your practice.”

What do you think? Is Alicia right in her calculations?

Do you know of a PT-specific documentation system that could make Alicia’s and Peter’s dreams come true?

Physical Therapy Practice Management | Referrals and Patient Flow

“If I haven’t had a patient from this doctor in a while, I’ll hit him with a text message, “Hey do you want to go out and have dinner, haven’t seen you in a while.” Keep that relationship strong, that’s the key.”

– Mike Walsh, PT
Dover, Delaware



[youtube_video] 1rsnNRj6klI [/youtube_video]

Michael Walsh, PT: I know who’s sending me patients.
Jason Barnes: Is it important to know, in terms of physical therapy practice management?
Michael Walsh: Absolutely, my network of providers. I have a network of 17 doctors and p.a.’s and nurse practitioners sending me patients. I have the benefit of having all of their cell phone numbers on my phone and I can communicate with them. So if I have a question with a post-op and I think a knee is infected, I can call the doctor. If I have a post-op back patient, and I think the patient is being non compliant, I can call him, right then and there. If I haven’t had a patient from this doctor in a while, I’ll hit him with a text message, “Hey do you want to go out and have dinner, haven’t seen you in a while.” Keep that relationship strong, that’s the key. They all trust me, they all know I’m good but they all trust me, and I can call them. They give me their cell phone number.
Jason Barnes: How do you know who is your biggest referral source?
Michael Walsh: I can look at the system and roll my cursor over and see who is there. I just know ahead of time who is my first. I would say right now at this moment, Dr. Hamblin is probably up there, Dr. Spangler is there. You know right now I have such and such from this guy and I haven’t seen any from this guy, I need to go knock on his door and see how he’s doing. We need to go out for dinner and find out whats going on and go fishing, you know. Keep that relationship strong. Because if I’m not doing it somebody else is.

Physical Therapy Software | Documentation System

physical therapy documentation

How to Measure the Impact of Your Physical Therapy  Documentation System on Your Bottom Line

By Amy Griffin, PT, Yuval Lirov, PhD, and Dave Macolino

Peter felt great this morning. He was happy to jump on his exercise bike, stretch his lower back and hamstrings, get a quick shower, and head straight to his physical therapy office. He knew his patient care schedule was full with at least fifteen or sixteen patients. Treating patients was the kind of work he loved so much.

His physical therapy practice was steadily gaining traction since opening one year ago. He was making a name for himself with several referring doctors as well as a solid community service reputation. Peter began thinking . . . . since he was seeing two patients per hour, charging an average $78 for a one hour visit, and working the standard 2,000 hours a year, that he was going to make about $312,000 a year.

Smiling to himself, Peter thought that perhaps in a year or two, he could hire a couple of assistants, increase the throughput to maybe 4 per hour and double his revenues to $624,000 a year. Peter envisioned a solid $6 million over the next decade. He could not wait to share his calculations with his young wife. They had been dreaming of building a house in a nice new development and a new SUV for her to bus their 7-year old and her friends to their daily soccer training sessions.

“Peter, will you skip dinner tonight again?” asked his wife Alicia. Peter had worked every evening in the past 2 months as well as all of the weekends. He had also missed all of their daughter’s soccer matches and he even forgot their wedding anniversary. Alicia was now wondering if the idea of Peter opening his own physical therapy practice was a good one. Was working for somebody else making $65,000 a year so bad? At least life was normal then.

“Maybe we should sit down tonight and talk.” Alicia said to Peter. “I really need to understand why you spend every evening and every weekend in the office.”

Peter started to feel a light headache and stressed with pressure from his wife. “You know honey, patient visit documentation is a compliance requirement. Both malpractice insurance and payers require it. Without visit documentation, we risk failing post-payment audits and incurring severe penalties including license suspension, fines and imprisonment. Is that the kind of risk you want me to take for us to have dinner together each night?”

“Peter, what about computerized documentation? What do you think about purchasing a physical therapy practice management software system that generates SOAP notes for you? I actually called around and discovered several physical therapy documentation systems that allow you to complete a note within 20 minutes.”

“All you have to do,” continued Alicia, “is to document patient complaints and comments in the Subjective section, document your findings in the Objective section, type your Assessment, and prepare your recommended treatment in the Plan section.”

“Alicia . . . ” Peter was getting tired of explaining the same thing again and again, “I know all there is to know about SOAP notes. My problem is that I need to type each and every note. How can I type an entire note in 20 minutes?”