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Caring for the complex pelvic patient with Physical Therapy

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Physical therapists specializing in pelvic health are confronted with a myriad of pelvic floor diagnoses and impairments which may result in pelvic organ prolapse (POP). Pelvic floor weakness secondary to muscle fiber damage or connective tissue abnormality may account for this phenomenon. Extenuating circumstances, such as a vaginal birth after cesarean section (VBAC), add further dimension to the patient’s presentation clinically. A 2014 study suggests that 65% of women experience successful VBAC deliveries, and there seems to be a growing trend of women requesting them.

I recently had the privilege to treat such a woman in the clinic. The patient was a 34 year old female referred to physical therapy (PT) by her obstetrician-gynecologist (OB-GYN) for evaluation of pelvic organ prolapse. The patient presented to physical therapy para 2 grava 2 (P2G2) indicating 2 pregnancies and 2 live births. On the day of evaluation she was 5.5 weeks post vaginal birth after cesarean (VBAC) of her second child. This three part series will analyze how documentation supported the evaluation, treatment, and outcomes of the patient.

At the time of initial evaluation her physician had not assigned a grade to her pelvic floor prolapse. Furthermore, the patient had not been evaluated for prolapse during cough; bear down, or in standing position, per patient report. Her primary concern was a feeling of heaviness and a sense that her organs were falling out, especially during standing and lifting tasks. Her physician had not yet performed a complete six week post-delivery examination, though this appointment was scheduled for three days after physical therapy evaluation.

The patient reported neither pain nor unintentional loss of urine (incontinence), though she felt weak throughout the abdominals and pelvic floor. Pertinent past medical history consisted of cesarean section 11/19/12 (almost two years prior to PT evaluation date) with subsequent hematoma at the surgical site which resolved with use of an abdominal binder. She is otherwise a very healthy woman with no comorbidities. The patient lives at home with her husband and two children, works as a physician assistant specializing in hospital based gastroenterology which requires prolonged standing during procedures and patient rounds.

She is an avid runner and aerobics instructor. She reports that there is good stress in her life with the birth of her second child. She was concerned that she would be unable to safely lift her toddler, run, or teach classes in her current state. Her primary goal was to be able to safely lift each of her children without the sense of heaviness in the pelvis. Secondary goals were to return to running and teaching aerobics classes which are her primary sources of recreation and stress reduction.

Physical Therapy Electronic Documentation

Click to Enlarge the image.

 

Past medical history is easily entered and accessible in the electronic chart.

There is burgeoning evidence to support physical therapy intervention for pelvic organ prolapse. A Cochrane Database System Review analyzed three randomized control trials (RCT’s) and found that pelvic floor muscle training may result in prevention of symptom worsening, and better self-reported patient outcomes. Furthermore, there is Level I evidence via 3-D ultrasonography that supervised pelvic floor training can increase PFM volume, close the levator hiatus, shorten muscle length, and elevate the resting position of the bladder and rectum in patients with POP. The researchers noted improvement in muscle thickness in both stage I POP and in symptomatic women with stage II or greater as determined by the Pelvic Organ Prolapse Quantification Scale (POP-Q).

As a measure of functional outcome, the patient was asked to complete the Pelvic Floor Impact Questionnaire-short form 7 (PFIQ-7). This outcome measure is a patient report of impact of symptoms of bladder, bowel, and prolapse impairments, and allows the therapist to gauge the level of impact and frustration that the patient experiences due to their symptoms so that treatment may be tailored to fit their individual needs. The PFIQ-7 was found in long form to be valid and reliable for women with disorders of pelvic floor including urinary and fecal incontinence, as well as pelvic organ prolapse. It is internally consistent (0.96-0.97), and reproducible (0.77-0.92), and the prolapse section was found to be significantly correlated with the stage of prolapse of the individual. The short form is faster for the patient to complete, and was found to maintain excellent correlation with the long form (r=0.95 to 0.96), with test-retest reliability P<.001). The outcome may be analyzed in subsets for bladder, bowel, and pelvic symptoms, respectively. This patient received a score total of 0 on the bladder and rectum subsets, and a score of 19 on the pelvis subset for a total score of 19 on the scale.

Musculoskeletal screening included assessment of posture in standing and sitting as this can be beneficial as an assessment of structural alignment according to the American Physical Therapy Association’s Guide to Clinical Practice 2nd Edition. The patient demonstrated mild forward head, mild anterior shoulder positioning with mildly increased thoracic kyphosis and lumbar lordosis. Pelvic symmetry was assessed by palpating the bony landmarks of the anterior superior iliac spine (ASIS) bilaterally, and the pelvis was mildly anterior rotated on the left. This pelvic position was verified in the supine position to account for possible interaction of limb length discrepancy. Limb length was measured and found to be insignificant with the right lower extremity measuring 1 millimeter longer than the right. Abdominal strength was graded 3+/5 as she was able to lower her legs no greater than a 60 degree angle while maintaining posterior pelvic tilt, according to Kendall’s muscle testing scheme.

PT examination sought to determine the nature of the heaviness in the pelvis through observation and palpation of the pelvic floor in supine hook lying position. This is done in order to assess the response of the pelvic floor and determine which walls of the pelvic floor appear to be affected.
Musculoskeletal physical therapy differential diagnosis included pelvic floor dysfunction resulting in prolapse, and increased abdominal pressure due to visceral adhesions from previous c-section.

Physical Therapy Electronic records

Click to Enlarge the image.

Documentation to demonstrate verbal and written consent for external and internal pelvic floor examination are pertinent.

bestPT is able to create unique objective components to demonstrate that consent has been verified. Furthermore it is possible to scan in and attach release forms that have been signed by the patient.

In the next installment, we will discuss treatment techniques in this unique women’s health sub-population.

-Amanda Olson, DPT

bestPT

Physical Therapy Documentation – Turning Attention to the Patient

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

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

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

Easy

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

 

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

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

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

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

PHI

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

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

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

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

-Amanda Olson, DPT

bestPT

Growth | Tackling Task Management

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Working It Out

Can Shannon get worked up enough about inefficient task management to make a change?

“One, two, three.” Shannon huffed and puffed her way through 20 repetitions on the bicep machine. “Ugh, I just don’t feel motivated today.”

“What’s the matter, Shannon?” asked Ariana, Shannon’s friend. “The machines seem to be winning against you today. What’s going on?”

The two went to an unoccupied corner of the gym. It was a quiet day,  they wouldn’t be bothering anyone over there.

“Everything seems to be going haywire at my practice,” said Shannon. “We’re all getting in each other’s way these days. The busier we’ve gotten, the more disorganized it feels.”

Ariana looked at her friend in surprise. She had always thought Shannon was unflappable, and she knew her practice had enjoyed steady growth. “What do you mean?”

“Well, I know Teresa is in charge of office orders but lately it seems like Tana and I are holding Teresa up by misplacing or checking over the list at the exact moment when she needs to be placing the order,” Shannon said. “Last week I needed a contact list so that I could make follow-up calls with patients but Teresa had it. She knew I was busy and made the calls for me, which was great, but I wasted 20 minutes looking for that list.”

“This sounds pretty familiar, I think any medical practitioner goes through the same annoyances,” said Ariana. “Typical growing pains. Except if you don’t get your processes under control, it makes growing your practice difficult to do.”

“That’s what I’m worried abou, what if we never get off this hamster wheel?” asked Shannon. “We’re wasting so much time getting in each other’s way that Teresa isn’t able to manage the office as efficiently and I’m not able to spend as much quality time with my patients.”

The two glanced toward the doorway as a mutual friend entered the gym, stopping to smile and wave.

“You know, Shannon, there are solutions out there,” said Ariana. “We are working with a company that is helping us through a program called a “ticket workbench.” It’s amazing: just by glancing at our screens, we can tell what tasks need to be done, what the deadlines are, and it enables us to prioritize. We can even tell who’s behind on their assignments so that another staff member can pitch in and help them get caught up.”

Shannon looked at her friend in amazement. “But how difficult is it to learn and implement?” she asked. “We’re already so overwhelmed, I’m nervous about causing additional stress to my team.

“Of course, there’s a small learning curve but most of us were up to speed by the end of our first day,” said Ariana. “I think the question you should be asking is this: what are you risking by not getting your practice under control? Without efficient task management, are you confident your files are compliant? Can you handle taking on any new patients? Will you be able to grow your practice, ever?”

Shannon looked thoughtful. “You’ve made some great points, Ariana, I think I need to do something about this situation soon,” she said. “But for now, I need to do something about my abs. Let’s get back to our workout!”

Now that Shannon understands that there’s a better way, can she find the will to tackle task management in her practice?

Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.

bestPT

Physical Therapy Documentation Shortcuts

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Our most popular xDocs templates:

  • Insurance Verification: Have relevant insurance information right there on the page with our v.2014.
  • Check lists: Create a custom checklist to review treatments with your patients, plan future treatments, or provide your patients with what they need to complete.
  • Grids: Keep a top-down view of all the details you need but don’t necessarily need for reporting.
  • Daily Notes: Some providers like a simple template with basic info. Others prefer a little more detail. Either way, xDocs can provide a fast solution.

Our documentation platform is maturing into an essential part of Physical Therapy practice management. Providers are loving our improvements and new template designs for editing and printing. In the last 12 months, the number of patient visits documented on xDocs has tripled.

 

Physical therapists are beginning to realize the power of having fast, simple documentation in the travel card and on patient files. It’s easy to create, edit, review and sign documents in xDocs. Here are some trends we’ve noticed from our practices with the highest visit rates and the lowest A/R over 120 days:

  • Less is more. Extra information makes it harder for you to find relevant information later. Place only the most relevant details in addition to the compliance requirements. Payers make it hard enough on you already; there’s no need to complicate it further.
  • More than just a paper substitute. If you find yourself writing the same things again and again, you can request that the xDoc have those phrases built in as defaults, or as an option to click and fill out the form automatically. Clicking or tapping a field is much quicker than writing it out.
  • Not all in one form. The providers who use xDocs the most get paid the most — and they’re not paying for bulkier, slower systems. xDocs is organized to be quickly accessed and reviewed; providers have much better results when they keep the documents organized for their purpose. While we have and are improving the comprehensive evaluations, the providers who treat more patients and get their payments, split the reporting documents from the recording documents. The insurance companies and Medicare don’t need to see many of the visit’s details; you’re just giving them more ammo to come up with reasons to delay or withhold the payments for your work. Our combined experience is used to help ensure you document everything that you need for your payors and nothing that you don’t need.

If you do not currently use xDocs, ask your Coach about getting started.
Your Coach can review your existing documents to help you get the best results.

Tom Jorno

Physical Therapy Software Sweet Dream Practice Analysis

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DPAblog4-bestPTSweet Dreams

Has Shannon’s Dream Practice Analysis left her feeling like life is sweet?

“Hey, it’s my favorite customers!” Mike kissed his wife and ruffled the kids’ hair as they slipped in through the back door of his restaurant.

“Hi, Shannon,” said the chef. “I think we might have some treats for the kids.”

“Treats?” they chorused.

“Mostly broccoli and asparagus,” teased the chef, “but there might be a cookie or two as well.”

“We should probably get them out of the kitchen, Shannon,” Mike suggested. “It’s not the safest place for a passel of kids, especially when we get busy. Grab a stalk of broccoli, kids, and let’s go find a table.”

Mike checked the whole kitchen with a glance and, satisfied, shepherded his family out to a table in a quiet corner of the restaurant.”

“Runs like a dream, doesn’t it?” Shannon said, grabbing a cookie from the plate she’d carried out.

“Most of the time,” Mike agreed. “I’ve worked very hard to get it this way, but now I have just enough excitement to keep it interesting.”

Mike and Shannon smiled at each other for a moment over their children’s heads. Then Mike remembered. “Today was your Dream Practice thing, right?”

“Right,” echoed Shannon. “It was great. Really, just going through the process has clarified things for me. You were right; it’s been a while since I took a high level look at my business.”

“It’s easy to get distracted,” Mike smiled.

“Very easy. But we went through the difference between ROI and expenses and compared our practice stats with some industry benchmarks for the things we offer, and it really made sense. I’d say it gave me some direction.”

“Just going through the figures probably helped a lot.”

“With an objective expert perspective, yes. We hadn’t really identified the right metrics to track. We didn’t capture all the data we should and we didn’t really know what to do with the information we had,”

“So the Dream Practice process really showed you all that?”

“Plus some opportunities and even some guarantees. I’m really glad I did it.”

The cookies were gone and the kids were getting restless, but Shannon had just wanted to share her satisfaction with her husband. A quick visit was better than waiting till Mike got home after the restaurant closed.

“I’d better get these three home and ready for bed. Thanks for taking some time out.”

Mike bent down to get kisses from the kids and saw his family out.

Has Shannon’s Dream Practice Analysis left her feeling like life is sweet?

Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.

Tom Jorno

Physical Therapy Software Practice Analysis

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DPAblog3-bestPTIf Life Could Be a Dream

Will crunching the numbers in a practice analysis help Shannon and Theresa get closer to the dream?

Shannon headed back in to work with a spring in her step. “Theresa,” she said, “do you remember when we first opened this place?”

Theresa smiled. “Of course. We were two crazy kids with a dream!”

“How close are we to that dream today?” Shannon asked.

“Pretty close,” said Theresa. “We’d be closer if we could redecorate the way you keep promising–”

Shannon laughed. “Seriously, how close are we?”

“Seriously, I think we’ve accomplished a lot. We have a great practice here, we’re helping our patients, supporting a lot of good people, and adding value to the community. I think that’s what we wanted to do, and we’ve basically done it.”

“There are some things that we haven’t accomplished, though, aren’t there? And maybe new things that have come up since we started, too.”

“Like redecorating,” Theresa couldn’t resist saying. Then she went on more soberly. “You’re right, though. There are a lot of things that get put off for lack of time, and I guess you and I might not be earning what we thought we would by now… and maybe not getting as much time off as we expected to, either.”

“So do you think there’d be some value in doing that Dream Practice Analysis we’ve been talking about?”

“If you want to do it, we’ll do it,” said Theresa tartly. “But I think you should consider the pros and cons. I agree that it might be helpful to have someone with a more numbers-oriented mindset to help us make sure we’re on the right path. Heck, it can be great just to have an objective outsider who doesn’t have so much emotion invested. But you’re talking about opening up our books to a stranger.”

“An expert. And I think we just share some information, the numbers they actually need and know what to do with — unlike you and me. I know we won’t have to share any information that shouldn’t be shared.”

“Fine. But will that information really let these experts give us an accurate prediction about how the software might be able to reduce our costs? We might just end up spending more because of double talk about saving.”

“I don’t think so,” Shannon objected. “I think that’s exactly why we need to go through the process. With actual data and someone who fully understands it, we could make our decision based on real information. We know that doing without things we really need is just false economy. We certainly did enough of that in the early days! But I don’t want to guess whether an investment is going to pay off. That’s why I think we should go through the process.”

Theresa agreed and turned back to the files she was working on, but she tossed a last question at Shannon as she moved away. “Can we ask about the ROI of redecorating while we’re at it?”

Will crunching the numbers in a practice analysis help Shannon and Theresa get closer to the dream?

Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.

Tom Jorno

Physical Therapy Software Dream Practice Analysis

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DPAblog2-bestPTLife is But a Dream

For Shannon, it’s essential to look back in order to look forward

Can a Dream Practice Analysis clarify Shannon’s real-world path?

Tell me again what DPA is, said Mike, raising his voice to be heard over the shouts of the children. Mike and Shannon had come to the park to play with their kids, but they were ready for a break. Shannon had mentioned DPA on the drive over, but Mike had’t caught what it was.

It stands for ˜Dream Practice Analysis, Shannon explained. It’s part of figuring out the ROI of my practice management software. But I dont think I understand ROI well enough to be able to figure it out.

Do you have to figure it out yourself?

I asked Theresa for help, but we couldnt seem to sort it out, and shes the one who keeps the books. Shannon laughed ruefully. That sounds bad, doesnt it?

It sounds like you need some help, thats for sure. Theresa can keep track of your income and expenses, I’m sure. But ROI is about investments. By figuring out the return on a potential investment — like practice management software — you can tell whether its a wise decision or not.

I think thats the point of the DPA process, Shannon agreed. Well analyze the Dream Practice and see how much time and money I can save by automating some of our processes with software.

It sounds like a good thing to do, Mike observed. How long has it been since you slowed down enough to think about what your Dream Practice would look like?

Good question. Shannon sat back and gazed around the park. It was an idyllic setting, full of happy children, dogs, and people enjoying the sunshine. It was easier to think about her Dream Practice here than in the office.

In the office, she was often distracted by fires needing to be put out, personal issues among the staff, and a general sense of chaos. Everything seemed to need dealing with on a case-by-case basis and every problem seemed like a new issue that had to be figured out and solved¦ or worse yet, the same old problem that never got solved but still had to be dealt with.

I love my business, Shannon said at last.

I know you do. Mike put an arm around his wife’s shoulders.

But you’re right. Ive lost track of the dream.

Dreams are different from reality, but your dreams can certainly help inform your decisions. If a DPA will help you see what kind of ROI you could get from an investment and help you make the right decision about the best investments in your practice, its worth doing.

Shannon nodded. She was still watching the kids, but it seemed to Mike that she might also be seeing her Dream Practice in her minds eye.

Can a Dream Practice Analysis clarify Shannon’s real-world path?

Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.

Tom Jorno

Physical Therapy Software Return on Investment

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DPAblog1-bestPTThe Numbers Game

Learning to distinguish between expenses and investments

Does ROI apply to Shannon’s PT practice?

Theresa stared blankly at Shannon. “I just don’t understand the question,” she said.

“I’m asking about the ROI — the return on investment. Like, which of our patients are most profitable. What kind of merchandise gives us the best return on our investment. When we do marketing, what return do we get for each kind of promotion or campaign.’

Theresa looked doubtfully at her computer screen. “I know what we spend and I know what we take in, and any time we spend less than we take in, I know I’m happy about it. I don’t think I can break things down the way you’re asking, though.”

“Say I wanted to hire a new technician. We’d have to think about all the costs of that new technician, compared with the amount of revenue we’d be able to get from being able to handle more patients, right?”

Theresa warily agreed.

“So we’d have to know exactly how much more money we’d make by bringing in those new patients and exactly how much it would cost to bring on the new technician. Like, if we could bring in another technician for a total of $4,000 a month counting benefits and extra coffee and toilet paper, and we could bring in $5,000 in new revenue by having one more technician on board, our ROI would be $1,000.”

“I know what ROI means,” Theresa objected. “I just don’t think we have the information to break it down like that. I can tell you what we pay one of our technicians now, but I don’t think I know how many new patients one new technician would allow us to bring in.”

“Not to mention the extra cost of coffee and toilet paper.”

Theresa laughed. “Exactly. The amount of time a client takes isn’t consistent — even with one client over time. Even if we imagine that each client pays exactly the same amount each time, we can’t really say that 10 new clients will bring in X amount of revenue, because it depends.”

“That’s true,” Shannon nodded. “Plus, just bringing in a new technician doesn’t automatically bring in 10 new clients, even if he or she increases our capacity by that amount.”

“Very true.” Theresa frowned at the screen some more. “Some of our cases bring in a lot more revenue than others, and some of our technicians have more patients but actually bring in less money. And we also sell a lot of merchandise now, and that income doesn’t necessarily line up with any of the technicians.”

“Or,” Shannon suggested, “we don’t keep track of things in a way that shows how it lines up.”  She leaned over the counter to look at the screen, too, but she couldn’t really get any information from the numbers she saw.”

“It’s also hard to figure out how to divvy up the costs,” said Theresa. “That’s a big part of ROI, but we don’t really know what the investment is. We can’t just divide up the cost of the coffee among all the technicians. We can say one pound of coffee lasts a week and costs five dollars, and if we have ten people on staff, that’s 50 cents per person, but really if we only have seven people on staff, we’re probably still going to finish that coffee in a week.”

Shannon’s head was beginning to hurt. “And I guess we can’t really divide the cost of coffee among all the clients, because we’ll drink the coffee no matter how many clients we have that week. I’m confused about this, really. I understand that it’s important, but I don’t know how to figure it out. People talk about fixed costs and variable costs, but where does coffee fit in?”

Theresa nodded. “I know how much it costs to keep the doors open and the lights on every month, and I can use that to figure out how many patients we have to see. But it doesn’t seem to work out in real life. The cost per hour per client always looks like it would be right, but even when we’re busy and have no unusual expenses, I never feel like things are just the way I expect them to be.”

“This stuff makes me feel like my head is about to explode,” Shannon confessed. “It seems as though we ought to be able to say the fixed costs are X number of dollars no matter how many clients we have.”

“I guess that’s true. The rent, the utilities, and the coffee really don’t depend on how many appointments we have.”

“But some of our costs must depend on the number of people we see.”

Shannon and Theresa were both staring at the screen. They fell silent, as though inspiration were about to descend on them.

At last, Theresa shook her head. “As long as I get all the bills paid and payroll covered, I’m happy.”

“Yeah, okay,” said Shannon ruefully, “but that doesn’t answer my questions about ROI.”

“Maybe ROI doesn’t apply to us,” suggested Theresa. “Maybe it works if you’re making widgets in a factory, but once you bring people into the mix, it doesn’t work any more.”

Does ROI apply to Shannon’s PT practice?

Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.

bestPT

Physical Therapy EHR Software | Healing Star Dream Practice of the Month

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physical therapy billing software_Healing Star Dream Practice

Philip Joshua MPT, COMT, OCS (on left) – Trina Peduto Colford, Front Desk Coordinator – Varghese Paul MPT, COMT (on right)

Healing Star Physical Therapy is a shining example of a growing dream practice with steady improvements in billing, workflow optimization and patient relationships.

Building a dream practice requires a concerted team effort, expertise, and hard work. At Healing Star, Philip Joshua MPT, COMT, OCS, Varghese Paul MPT, COMT, and Front Desk Coordinator Trina Peduto Colford work together to achieve this goal. They balance all aspects of practice management with bestPT physical therapy software and billing services.

Optimizing the workflow with the right methodology and software eliminates stress and frees up time, so that both PTs at Healing Star can help more patients. With plans for opening another practice later this year it is clear that they are mastering both, workflow optimization and patient relationships.

Practice Radar (June-July 2013):

physical therapy documentation_Healing Star radar

Total # of Practice Tickets: Total amount of tickets on all practice workbenches.
AR 120: The percentage of insurance claim balances that were entered into the system over 120 days ago but are still not paid.
Total Billed: Totals the amount of services billed to insurance carriers and patients during that month.
Total Collected: Total amount collected from insurance and patient payments.
# Workbench Claims: Number of claims needing to be addressed.

physical therapy documentation_Candace SPOC

Profitability Coach Candace Coleman

Some of the reasons behind the successful growth of this PT practice are that the entire staff embraces bestPT’s methodology, ticketing system and coaching from their SPOC Candace Coleman.  Trina describes Candace as ‘Very helpful and patient with me – 5 thumbs up!’

Profitability Coach Candace Coleman:
“Ultimately, everyone at Healing Star understands the purpose of workflow tracking, accountability and teamwork. As case in point, Colford addresses the practice workbench each day while bestPT’s billing team aggressively follows up on claims to keep the AR over 120 days low.”

bestPT

Physical Therapy Software | New Network Members in August 2013

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physcial therapy software_ new network membersThirteen new members joined bestPT in August. Each member benefits from the size of  bestPT’s network as we use the shared knowledge in the battle against the payers. This proverbial strength in numbers helps you build your dream practice with our physical therapy documentation software and coaching services.

Let’s welcome bestPT’s newest members:

  1. Abigail Licona of Active Performance Physical Therapy, West Carroll, Iowa:  http://activeperformancept.com/
  2. Lauren Reineke and Lauren Lax of Big Sky Pediatric Therapy, Austin, Texas:  https://www.bigskyfriends.com/
  3. Melissa Schmidt, Megan Danley, and Heather Milligan of Elite Orthosport Physical Therapy, Los Angeles, California:  https://www.facebook.com/pages/Elite-Orthosport-Physical-Therapy/624536457586852
  4. Tina Simpson and Anna of Melwood Rehabilitation Center, Upper Marlboro, Maryland: http://www.melwoodrehab.com/
  5. Jennifer Berg of Midlothian Village Physical Therapy, Midlothian, Virginia: http://www.mvp-therapy.com
  6. Leslee Carroll of Mike Walsh Physical Therapy, Dover, Delaware: https://www.facebook.com/pages/Mike-Walsh-Physical-Therapy/121200377936032
  7. Fran Hill of Pearson Physiotherapy Specialists, Craig, Colorado: http://www.pearsonphysiotherapy.com/
  8. Stephen Edwards of Physical Therapy & Sports Rehabilitation Clinic, Terre Haute, Indiana: http://www.indstate.edu/rehabclinic/
  9. Erica Newman of Summit Physical Therapy, Hixson, Tennessee: http://summit-therapy.com