Re: ethical issues - awareness of fees

[Guest guest]

The following is a motion sponsored by the Arizona Chapter for this year's APTA

House of Delegates. It has widespread implications for practice in any practice

environment. The attached support statement provides additional focus on this

motion's application in practice.

Blair J. Packard, PT

=============

Policy on Awareness of Fees for Professional Services

Physical therapists have an ethical obligation to be aware of fees charged for

their services. Physical therapists should make an effort to insure that fees

charged for their services are reasonable. In cases where the fee for service

cannot be determined because of the payment methodology, the physical therapist

should be aware of the payment methodology in addition to any applicable fee

schedule associated with the billing for their services.

Support Statement: The purpose of adopting ethical policy or standards is to

make explicit what we implicitly already know or sense is right conduct.

Principles 5.1.B. and C. of the Guide for Professional Conduct address the

ethical responsibility that a physical therapist already has to attempt to

ensure that fee schedules are reasonable. The implication is that if fee

schedules are reasonable then it should follow that actual fees charged per

episode of care should also be reasonable. However, it is advisable in this

instance to make this explicit.

It has been a practice in far too many settings for a physical therapist to

check off procedural codes and be unaware of the actual billed charges. In some

settings this practice not only occurs, but it may be encouraged.

Unfortunately, there may be instances where this practice has been associated

with excessively high fees of which the physical therapist is not aware. Also,

in a few situations this practice may have been associated with upcoding of

charges by others not providing the actual care. Federal Bureau of

Investigation investigations into illegal billing practices have identified such

practices in the health care industry. Our profession should not attempt to

excuse any practitioner on the basis that such billing practices are routine or

that the provider was unaware of such billing practices.

Certainly, physical therapists should attempt to ensure that fee schedules are

reasonable, as current ethical standards address. Physical therapists should

also attempt to ensure that the application of those fee schedules through the

actual fees charged are also reasonable.

Where physical therapists provide care to a patient with an insurance contract

for payment that has a defined benefit limiting the services, it is appropriate

and expected that the physical therapist will take into consideration the

financial impact that the optimal course of care will have on the patient under

such limitations. This should be discussed with the patient so the patient can

make informed choices.

Payment methodologies such as case rate or capitated payment for services differ

considerably from traditional fee for service or from a defined benefit plan and

present unique challenges to providers. These plans usually contain contractual

obligations to provide medically necessary care for an agreed upon

reimbursement. In these arrangements the physical therapist should not allow

considerations of personal or institutional financial gain to determine the

course of care. The patient's course of treatment should be based on the

clinician's judgment of the patient's medical need. Physical therapists are not

excused from ethical obligations with such plans. A physical therapist who is

managing and providing the patient's care must be aware of these contractual or

payment methodologies in order to make sound clinical and ethical decisions in

the patient's best interest.

The step this motion requires is a natural sequence in the professional

development of physical therapists. As portal-of-entry or direct access

provider status is achieved, physical therapists must also have the ethical

perspective that the responsibilities of autonomous practice—including

determining a diagnosis, prognosis, treatment intervention and discharge from

service—must also be combined with the professional awareness of the payment

methodologies used in reimbursement for professional services. It is

unconscionable for a professional to provide services and not be aware of and

appreciate the financial impact of those services to their patient.

------------------------------------------------------------------------

[Guest guest]

Fantastic Post out of Arizona, Blair...It is about time that this is put in

writing...sort of makes the Standards of Practice more concrete...I wonder

what the corporate giants of PT would say about this. Kudos to Arizona

PT's!!! Don Walsh, MS, PT, OCS

Re: ethical issues - awareness of fees

> The following is a motion sponsored by the Arizona Chapter for this year's

APTA House of Delegates. It has widespread implications for practice in any

practice environment. The attached support statement provides additional

focus on this motion's application in practice.

>

> Blair J. Packard, PT

>

> =============

>

> Policy on Awareness of Fees for Professional Services

>

> Physical therapists have an ethical obligation to be aware of fees charged

for their services. Physical therapists should make an effort to insure that

fees charged for their services are reasonable. In cases where the fee for

service cannot be determined because of the payment methodology, the

physical therapist should be aware of the payment methodology in addition to

any applicable fee schedule associated with the billing for their services.

>

>

> Support Statement: The purpose of adopting ethical policy or standards is

to make explicit what we implicitly already know or sense is right conduct.

Principles 5.1.B. and C. of the Guide for Professional Conduct address the

ethical responsibility that a physical therapist already has to attempt to

ensure that fee schedules are reasonable. The implication is that if fee

schedules are reasonable then it should follow that actual fees charged per

episode of care should also be reasonable. However, it is advisable in this

instance to make this explicit.

>

> It has been a practice in far too many settings for a physical therapist

to check off procedural codes and be unaware of the actual billed charges.

In some settings this practice not only occurs, but it may be encouraged.

Unfortunately, there may be instances where this practice has been

associated with excessively high fees of which the physical therapist is not

aware. Also, in a few situations this practice may have been associated

with upcoding of charges by others not providing the actual care. Federal

Bureau of Investigation investigations into illegal billing practices have

identified such practices in the health care industry. Our profession should

not attempt to excuse any practitioner on the basis that such billing

practices are routine or that the provider was unaware of such billing

practices.

>

> Certainly, physical therapists should attempt to ensure that fee schedules

are reasonable, as current ethical standards address. Physical therapists

should also attempt to ensure that the application of those fee schedules

through the actual fees charged are also reasonable.

>

> Where physical therapists provide care to a patient with an insurance

contract for payment that has a defined benefit limiting the services, it is

appropriate and expected that the physical therapist will take into

consideration the financial impact that the optimal course of care will have

on the patient under such limitations. This should be discussed with the

patient so the patient can make informed choices.

>

> Payment methodologies such as case rate or capitated payment for services

differ considerably from traditional fee for service or from a defined

benefit plan and present unique challenges to providers. These plans

usually contain contractual obligations to provide medically necessary care

for an agreed upon reimbursement. In these arrangements the physical

therapist should not allow considerations of personal or institutional

financial gain to determine the course of care. The patient's course of

treatment should be based on the clinician's judgment of the patient's

medical need. Physical therapists are not excused from ethical obligations

with such plans. A physical therapist who is managing and providing the

patient's care must be aware of these contractual or payment methodologies

in order to make sound clinical and ethical decisions in the patient's best

interest.

>

> The step this motion requires is a natural sequence in the professional

development of physical therapists. As portal-of-entry or direct access

provider status is achieved, physical therapists must also have the ethical

perspective that the responsibilities of autonomous practice-including

determining a diagnosis, prognosis, treatment intervention and discharge

from service-must also be combined with the professional awareness of the

payment methodologies used in reimbursement for professional services. It is

unconscionable for a professional to provide services and not be aware of

and appreciate the financial impact of those services to their patient.

>

>

> ------------------------------------------------------------------------

>

[Guest guest]

Blair -

I understand the intent of this motion, but it seems it could have been said

with a simple " know what you are billing for " and " bill accurately for what

you do using the codes appropriately for the time frame of the treatment " .

To me, it seems to mix the " empathetic, patient advocate " side of PT with

billing ethics. The support statement almost appears to endorse down

coding, or manipulating your coding and ultimate visit charge to the

therapist comfort level - this defies business sense.

Is this patterned after any other organizations' statements (AMA,

Chiropractors, etc.)?

Todd Gifford, PT

Re: ethical issues - awareness of fees

The following is a motion sponsored by the Arizona Chapter for this year's

APTA House of Delegates. It has widespread implications for practice in any

practice environment. The attached support statement provides additional

focus on this motion's application in practice.

Blair J. Packard, PT

=============

Policy on Awareness of Fees for Professional Services

Physical therapists have an ethical obligation to be aware of fees charged

for their services. Physical therapists should make an effort to insure that

fees charged for their services are reasonable. In cases where the fee for

service cannot be determined because of the payment methodology, the

physical therapist should be aware of the payment methodology in addition to

any applicable fee schedule associated with the billing for their services.

Support Statement: The purpose of adopting ethical policy or standards is to

make explicit what we implicitly already know or sense is right conduct.

Principles 5.1.B. and C. of the Guide for Professional Conduct address the

ethical responsibility that a physical therapist already has to attempt to

ensure that fee schedules are reasonable. The implication is that if fee

schedules are reasonable then it should follow that actual fees charged per

episode of care should also be reasonable. However, it is advisable in this

instance to make this explicit.

It has been a practice in far too many settings for a physical therapist to

check off procedural codes and be unaware of the actual billed charges. In

some settings this practice not only occurs, but it may be encouraged.

Unfortunately, there may be instances where this practice has been

associated with excessively high fees of which the physical therapist is not

aware. Also, in a few situations this practice may have been associated

with upcoding of charges by others not providing the actual care. Federal

Bureau of Investigation investigations into illegal billing practices have

identified such practices in the health care industry. Our profession should

not attempt to excuse any practitioner on the basis that such billing

practices are routine or that the provider was unaware of such billing

practices.

Certainly, physical therapists should attempt to ensure that fee schedules

are reasonable, as current ethical standards address. Physical therapists

should also attempt to ensure that the application of those fee schedules

through the actual fees charged are also reasonable.

Where physical therapists provide care to a patient with an insurance

contract for payment that has a defined benefit limiting the services, it is

appropriate and expected that the physical therapist will take into

consideration the financial impact that the optimal course of care will have

on the patient under such limitations. This should be discussed with the

patient so the patient can make informed choices.

Payment methodologies such as case rate or capitated payment for services

differ considerably from traditional fee for service or from a defined

benefit plan and present unique challenges to providers. These plans

usually contain contractual obligations to provide medically necessary care

for an agreed upon reimbursement. In these arrangements the physical

therapist should not allow considerations of personal or institutional

financial gain to determine the course of care. The patient's course of

treatment should be based on the clinician's judgment of the patient's

medical need. Physical therapists are not excused from ethical obligations

with such plans. A physical therapist who is managing and providing the

patient's care must be aware of these contractual or payment methodologies

in order to make sound clinical and ethical decisions in the patient's best

interest.

The step this motion requires is a natural sequence in the professional

development of physical therapists. As portal-of-entry or direct access

provider status is achieved, physical therapists must also have the ethical

perspective that the responsibilities of autonomous practice—including

determining a diagnosis, prognosis, treatment intervention and discharge

from service—must also be combined with the professional awareness of the

payment methodologies used in reimbursement for professional services. It is

unconscionable for a professional to provide services and not be aware of

and appreciate the financial impact of those services to their patient.

------------------------------------------------------------------------

[Guest guest]

Todd,

Thank you for your response and questions. Indeed the motion does encompass the

issues of knowing " what one is billing for " and " billing accurately. " But the

AZ motion goes beyond that. Do you disdain the position of patient advocate?

Our professional ethic at times requires us to take a position of patient

advocate. Ethics inherently means that the professional provider makes morally

right clinical AND business decisions with each patient's welfare in mind. That

happens one-to-one: between a provider and their patient. " Billing ethics " and

" business sense, " as you put it, may or may not have anything to do with our

professional ethic where patient-centered care is concerned.

The bottom line is that every single physical therapist as a professional

provider, and not just administrators and managers, should have an awareness and

knowledge of fees and payment methodologies and must apply this knowledge to

what they are doing as they render professional services. That is a necessary

element of making ethical decisions as a provider. Until we (all PTs) reach that

level we may be functioning at a technical level, as workers filling a job, but

not at a professional level.

Regarding your question about what this motion may be patterned after - it is

not patterned after any other profession's or organization's documents that I'm

aware of. It is consistent with and follows our own core ethical documents - the

APTA Code of Ethics and the Guide for Professional Conduct.

Blair J. Packard, PT

> Blair -

>

> I understand the intent of this motion, but it seems it could have been said

> with a simple " know what you are billing for " and " bill accurately for what

> you do using the codes appropriately for the time frame of the treatment " .

>

> To me, it seems to mix the " empathetic, patient advocate " side of PT with

> billing ethics. The support statement almost appears to endorse down

> coding, or manipulating your coding and ultimate visit charge to the

> therapist comfort level - this defies business sense.

>

> Is this patterned after any other organizations' statements (AMA,

> Chiropractors, etc.)?

>

> Todd Gifford, PT

>

>

> Re: ethical issues - awareness of fees

>

>

> The following is a motion sponsored by the Arizona Chapter for this year's

> APTA House of Delegates. It has widespread implications for practice in any

> practice environment. The attached support statement provides additional

> focus on this motion's application in practice.

>

> Blair J. Packard, PT

>

> =============

>

> Policy on Awareness of Fees for Professional Services

>

> Physical therapists have an ethical obligation to be aware of fees charged

> for their services. Physical therapists should make an effort to insure that

> fees charged for their services are reasonable. In cases where the fee for

> service cannot be determined because of the payment methodology, the

> physical therapist should be aware of the payment methodology in addition to

> any applicable fee schedule associated with the billing for their services.

>

>

> Support Statement: The purpose of adopting ethical policy or standards is to

> make explicit what we implicitly already know or sense is right conduct.

> Principles 5.1.B. and C. of the Guide for Professional Conduct address the

> ethical responsibility that a physical therapist already has to attempt to

> ensure that fee schedules are reasonable. The implication is that if fee

> schedules are reasonable then it should follow that actual fees charged per

> episode of care should also be reasonable. However, it is advisable in this

> instance to make this explicit.

>

> It has been a practice in far too many settings for a physical therapist to

> check off procedural codes and be unaware of the actual billed charges. In

> some settings this practice not only occurs, but it may be encouraged.

> Unfortunately, there may be instances where this practice has been

> associated with excessively high fees of which the physical therapist is not

> aware. Also, in a few situations this practice may have been associated

> with upcoding of charges by others not providing the actual care. Federal

> Bureau of Investigation investigations into illegal billing practices have

> identified such practices in the health care industry. Our profession should

> not attempt to excuse any practitioner on the basis that such billing

> practices are routine or that the provider was unaware of such billing

> practices.

>

> Certainly, physical therapists should attempt to ensure that fee schedules

> are reasonable, as current ethical standards address. Physical therapists

> should also attempt to ensure that the application of those fee schedules

> through the actual fees charged are also reasonable.

>

> Where physical therapists provide care to a patient with an insurance

> contract for payment that has a defined benefit limiting the services, it is

> appropriate and expected that the physical therapist will take into

> consideration the financial impact that the optimal course of care will have

> on the patient under such limitations. This should be discussed with the

> patient so the patient can make informed choices.

>

> Payment methodologies such as case rate or capitated payment for services

> differ considerably from traditional fee for service or from a defined

> benefit plan and present unique challenges to providers. These plans

> usually contain contractual obligations to provide medically necessary care

> for an agreed upon reimbursement. In these arrangements the physical

> therapist should not allow considerations of personal or institutional

> financial gain to determine the course of care. The patient's course of

> treatment should be based on the clinician's judgment of the patient's

> medical need. Physical therapists are not excused from ethical obligations

> with such plans. A physical therapist who is managing and providing the

> patient's care must be aware of these contractual or payment methodologies

> in order to make sound clinical and ethical decisions in the patient's best

> interest.

>

> The step this motion requires is a natural sequence in the professional

> development of physical therapists. As portal-of-entry or direct access

> provider status is achieved, physical therapists must also have the ethical

> perspective that the responsibilities of autonomous practice—including

> determining a diagnosis, prognosis, treatment intervention and discharge

> from service—must also be combined with the professional awareness of the

> payment methodologies used in reimbursement for professional services. It is

> unconscionable for a professional to provide services and not be aware of

> and appreciate the financial impact of those services to their patient.

>

>

> ------------------------------------------------------------------------

>

[Guest guest]

In a message dated 4/3/99 6:31:47 PM Central Standard Time, rwhpt@...

writes:

<< So, I decided to spend the last decade of my career helping other

therapists prepare for that time. Most therapists are so unskilled in the

business and economics arena that they are routinely abused by attorneys,

insurors, patients, doctors, and others with an interest in getting treatment

but evading fair payment. Therapists are entitled to beter treatment than

that, but they may have to fight for it. >>

Like Dick, I have struck out on my own looking for a way to be of assistance,

rather than stand back and watch or assist in the carnage of consolidation.

The saddest part about a therapist doing business right now is that they are

only as good as their front office staff is in handling the battles of

reimbursement. So many therapists are doing a nice job of running their

practice, but they are concerned about the future. The big selling point for

national companies is, " get out while you still can. " The problem that I saw

is that once a practice is sold, the people that made up that practice lose a

heck of a lot of their identity. Right now you have a choice of continuing

on with your practice or sell to a larger chain. Ken Mailly or Elmer Platz

said that the ability to align with other PTIP's is there, but there is still

a lot of skeptism about sharing information (please forgive me if I am not

quite on target with that quote). In order to survive and thrive in the next

couple of years, I would encourage people to continue to share on this board

and look at ways to " color outside the lines " . The practices of the next

quadrenium will have to explore ways to reengineer the way they do business.

There are quite a few HMO's that are preying on the PTIP. Please don't

misunderstand me, I think HMO's can be a positive in the marketplace.

However, signing a contract at a ridiculously low rate because someone else

will do it if you don't is not an acceptable way of doing business. If you

are going to give in on rates, the HMO needs to make concessions as well.

In addition to the HMO's, there are a few companies that are charging money

to " get you into managed care contracts " . After a company of mine paid money

to get into one of these contracts, they found that their was no further

business steering into our clinics. Instead, pre-existing business was

discounted and no steerage was provided. AND WE PAID FOR THE OPPORTUNITY TO

USE THIS SERVICE!!! Keep looking at ways to change the way you do business,

but if you are going to give something up, make sure you are getting

something in return!

I'm off my soapbox now.

Have a very blessed easter!

Jim Hall, CPA <///><

Rehab Management Services, LLC

Cedar Rapids, IA 52401

319/365-6384

COME AND VISIT OUR WEB PAGE AT:

http://members.aol.com/JHall49629/

------------------------------------------------------------------------

[Guest guest]

Blair and Todd --

" I'm not aware of many PT educational programs that require undergraduate business classes as a prerequisite to PT school, nor is much offered in business or practice management within our professional programs... "

I'm 53 years old. In five years, someone will have figured out how the system works and written it down so that therapists may earn a fair wage by treating patients in their communities. By then I'll be 58. If I were to start up (yet another) clinic then, I'd be 63 by the time it got five years in.

So, I decided to spend the last decade of my career helping other therapists prepare for that time. Most therapists are so unskilled in the business and economics arena that they are routinely abused by attorneys, insurors, patients, doctors, and others with an interest in getting treatment but evading fair payment. Therapists are entitled to beter treatment than that, but they may have to fight for it.

In addition to doing some teaching (L.A.M.P.) in a PT program and quite a bit in graduate and undergraduate business programs, I'm putting together some programs to address the need you mentioned. We're doing, " Introductory Business Skills " , " Intro to Finance " , " Intro to HR " , and " Strategic Management for Therapists. "

Rather than get into " Advertisement " mode, I'll leave it at that. You have raised a fine topic!

Dick Hillyer, MBA, MSM, PT

Hillyer Associates, Inc.

Town & Country PT, Inc.

Millsboro, Delaware

rwhpt@...

[Guest guest]

Unlike Dick, I did have business management classes in my PT program, small as it was.And have had to opportunity to teach business concepts, patient management at atherapy school. Usually not the students favorite class.Like Dick and Jim, I too have set my goals on the business side to assist therapistsincrease their business awareness to survive.We have a wonderful profession and so much to offer patients.Thank you for your insight and starting PTManager.As a mentor of mine once said, " Everything in life is negotiable. " We just need to tools to negotiate a win-win outcome.Hope everyone is haveing a wonderful Easter with family and friends.Sheri L. Bjork, PT, MBAJS Consulting

<< So, I decided to spend the last decade of my career helping other therapists prepare for that time. Most therapists are so unskilled in the business and economics arena that they are routinely abused by attorneys, insurors, patients, doctors, and others with an interest in getting treatment but evading fair payment. Therapists are entitled to beter treatment than that, but they may have to fight for it. >>

Like Dick, I have struck out on my own looking for a way to be of assistance, rather than stand back and watch or assist in the carnage of consolidation. The saddest part about a therapist doing business right now is that they are only as good as their front office staff is in handling the battles of reimbursement. So many therapists are doing a nice job of running their practice, but they are concerned about the future. The big selling point for national companies is, " get out while you still can. " The problem that I saw is that once a practice is sold, the people that made up that practice lose a heck of a lot of their identity. Right now you have a choice of continuing on with your practice or sell to a larger chain. Ken Mailly or Elmer Platz said that the ability to align with other PTIP's is there, but there is still a lot of skeptism about sharing information (please forgive me if I am not quite on target with that quote). In order to survive and thrive in the next couple of years, I would encourage people to continue to share on this board and look at ways to " color outside the lines " . The practices of the next quadrenium will have to explore ways to reengineer the way they do business. There are quite a few HMO's that are preying on the PTIP. Please don't misunderstand me, I think HMO's can be a positive in the marketplace. However, signing a contract at a ridiculously low rate because someone else will do it if you don't is not an acceptable way of doing business. If you are going to give in on rates, the HMO needs to make concessions as well.

In addition to the HMO's, there are a few companies that are charging money to " get you into managed care contracts " . After a company of mine paid money to get into one of these contracts, they found that their was no further business steering into our clinics. Instead, pre-existing business was discounted and no steerage was provided. AND WE PAID FOR THE OPPORTUNITY TO USE THIS SERVICE!!! Keep looking at ways to change the way you do business, but if you are going to give something up, make sure you are getting something in return!

I'm off my soapbox now.

Have a very blessed easter!

Jim Hall, CPA <///><

Rehab Management Services, LLC

Cedar Rapids, IA 52401

319/365-6384

COME AND VISIT OUR WEB PAGE AT:

http://members.aol.com/JHall49629/

[Guest guest]

I once met a physiatrist who exclaimed, " I can't even afford myself " ;

(referring to his administration setting his professional fees)

FYI.........Don Walsh, MS, PT, OCS

Re: ethical issues - awareness of fees

> >

> >

> > Todd,

> >

> > Thank you for your response and questions. Indeed the motion does

encompass

> > the issues of knowing " what one is billing for " and " billing

accurately. "

> > But the AZ motion goes beyond that. Do you disdain the position of

patient

> > advocate? Our professional ethic at times requires us to take a

position of

> > patient advocate. Ethics inherently means that the professional provider

> > makes morally right clinical AND business decisions with each patient's

> > welfare in mind. That happens one-to-one: between a provider and their

> > patient. " Billing ethics " and " business sense, " as you put it, may or

may

> > not have anything to do with our professional ethic where

patient-centered

> > care is concerned.

> >

> > The bottom line is that every single physical therapist as a

professional

> > provider, and not just administrators and managers, should have an

awareness

> > and knowledge of fees and payment methodologies and must apply this

> > knowledge to what they are doing as they render professional services.

That

> > is a necessary element of making ethical decisions as a provider. Until

we

> > (all PTs) reach that level we may be functioning at a technical level,

as

> > workers filling a job, but not at a professional level.

> >

> > Regarding your question about what this motion may be patterned after -

it

> > is not patterned after any other profession's or organization's

documents

> > that I'm aware of. It is consistent with and follows our own core

ethical

> > documents - the APTA Code of Ethics and the Guide for Professional

Conduct.

> >

> > Blair J. Packard, PT

>

> ------------------------------------------------------------------------

>