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Re: Coverage Issues

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Nice job, Ken. I have thought for quite a while that the APTA should have a

specialization process for us " generalists " for whom treating in whatever

setting, whichever patient has become a challenging, rewarding way of

(professional)life. Thanks for your words.

PT

Clinical Coordinator of PT

Sheltering Arms

Richmond, VA

Fwd: Coverage Issues

I'm utilizing energy conservation techniques.

Ken

> We have had many discussions on this listserve about the problems

> associated with " Reimbursement driving Practice " , rather

> than " Practice driving Reimbursement " . We all bemoan how this

> decreases the quality of patient care and leads to ethical and

> potential legal problems with delivering care. I certainly agree

> with these points and share these concerns.

>

> Having said all of this, I find it incredibly ironic when I hear

> people discuss " coverage " issues in facilities and practices. The

> issue almost always concerns " How are we going to assure continuity

> of care for patients when their therapist is not around? " The

> undercurrent to this discussion is actually: How is the

> facility/practice going to assure continuity since they are the ones

> billing? In other words, it is " their " problem.

>

> This makes me absolutely crazy! I recall a conversation that I once

> had with a Rehabilitation department about Weather Emergencies, and

> what the policy would be for employees who could not make it to

> work. When I was asked how the employees who did make it would be

> treated in comparison to those who did not, I asked the following

> question: " How will we assure that the patients would be treated? "

>

> I was greeted with quizzical looks. They reiterated their question

> about what the policy would be, and I then reiterated my

> question: " How will we assure that the patients would be treated? "

> As their frustration continued to mount (as your may be now!) I

> simply said that if we did not answer my question first, we would

> never get to their question.

>

> The point is that we are responsible for assuring the proper

> treatment, and continuity of care for our patients. If we are more

> concerned about our time off concerns than our patients, then we

> should not be taken seriously as " professionals " . The plan of care

> for a patient must be developed according to the identified clinical

> needs of the patient. If we develop this plan based on " coverage "

> issues, we are shirking our professional, ethical, and legal

> responsibilities. This is what is meant by " Reimbursement driving

> Practice " .

>

> If we persist in allowing therapists to be Outpatient Specialists,

> Inpatient Specialists, Subacute Specialists, etc. we are reinforcing

> Reimbursement driving Practice. I refuse to believe that a therapist

> seeing a patient today, does not know how to treat the patient

> tomorrow after they have been transferred. It is the setting which

> had changed, not the patient! Just because these settings are

> regulated and reimbursed differently does not mean we can not, or

> should not, see the patient through.

>

> That is where we need to get ourselves!

> That is " Practice driving Reimbursement " !

>

> Ken Mailly, PT

> Mailly & Inglett Consulting

> Wayne, NJ

> Director of Government Affairs/Professional Affairs Representative

> NJ Chapter, APTA

> --- End forwarded message ---

>

> Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

Rochester Michigan. Register at today.

>

> Coming Soon - Rehab Pro - The New Way...A Better Way to Rehab Success!

> LAMP Summit 2000. July 23-25, 2000 Register at .

>

> Visit our EStore at www.RehabBusiness.com

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" The onus is not on APTA to educate us, it is on me to learn as the

professional clinician. "

What a thought, Ken! I'd submit that the APTA actually IS us.

Despite the experience that some of us may have had with paternalistic

social institutions, we ourselves are at least 80% responsible for our

own destinies. When we cluster together in an affinity group such as

the APTA, we actually contribute to what that becomes, not so much the

other way around. This is good: We strengthen our own support

structures that way.

Some of what the group is, also rubs off on us, but to a lesser extent.

So, (if I may plug my old employer, the US Army Medical Department) ...

" Beee Alll That Youuu Cannn Beee! "

Dick Hillyer, PT, TLK

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  • 3 weeks later...
Guest guest

Ken, I agree that a patient's continuity of care and appropriate care plan

are extremely important. But you cannot ignore the reimbursement and

business end of our profession these days. Therapists must be aware of

coverage restrictions in order to provide the most appropriate and efficient

therapy for their patients. The purse strings have tightened significantly

as a result of the BBA of 1997. In order to succeed in our profession these

days, we must continue to search for " best practice " techniques. They may

need to be developed for an HMO patient authorized for 4 visits s/p ACL

reconstruction and one authorized for 24 visits. Unfortunately, all

insurances are not created equal. Clinics may have a little lattitude for

charity, but it is limited. We must keep the business aspect of our

profession in the forefront.

The key is to be able to balance efficient business techniques with

quality care so our practicies may survive these difficult times.

I look forward to any feedback.

Bob Rohack, PT

Rehab Supervisor

Bethesda Memorial Hospital, Boynton Bch, FL

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Bob:

I will challenge you, however, that if you are able to successfully rehab the

patient with the ACL repair using 4 total visits -

then why would you need 24 just because 24 are authorized? If we do one in 4

visits - then all should be tried in 4 visits. Just

my $0.02...

Ed Flickinger, PT, MBA

ROHACK007@... wrote:

> Ken, I agree that a patient's continuity of care and appropriate care plan

> are extremely important. But you cannot ignore the reimbursement and

> business end of our profession these days. Therapists must be aware of

> coverage restrictions in order to provide the most appropriate and efficient

> therapy for their patients. The purse strings have tightened significantly

> as a result of the BBA of 1997. In order to succeed in our profession these

> days, we must continue to search for " best practice " techniques. They may

> need to be developed for an HMO patient authorized for 4 visits s/p ACL

> reconstruction and one authorized for 24 visits. Unfortunately, all

> insurances are not created equal. Clinics may have a little lattitude for

> charity, but it is limited. We must keep the business aspect of our

> profession in the forefront.

>

> The key is to be able to balance efficient business techniques with

> quality care so our practicies may survive these difficult times.

>

> I look forward to any feedback.

>

> Bob Rohack, PT

> Rehab Supervisor

> Bethesda Memorial Hospital, Boynton Bch, FL

>

> Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

Rochester Michigan. Register at today.

> Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details

> LAMP Summit 2000. July 23-25, 2000 Register at .

> Visit our EStore at www.RehabBusiness.com

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In a message dated 07/15/2000 3:13:37 PM Central Daylight Time,

ROHACK007@... writes:

<< The key is to be able to balance efficient business techniques with

quality care so our practicies may survive these difficult times.>>

Bob;

Very eloquently stated! Successful practices will need to partner with their

business office staff and spend more time learning what is going on. The

weakest component of any clinic is not in the treatment area. Unless time is

spent to learn and facilitate the front office, practices will continue to

struggle and some will fail. Therapists have continuing education

opportunities, but front office staff still suffer from the stereotype that

the best front office staff is one that accepts minumum wage and understands

the success of a practice hinges on the quality of therapy provided. I

realize that my statements are controversial, but until practitioners devote

as much attention to the business side of their practice, they will continue

to suffer financially.

Okay, I'm out of the pulpit this Sunday morning.

Jim

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Guest guest

Bob & Jim:

You're both quite correct! If a practice fails

the cause is not likely to be poor treatment

or patient management skills but inadequate

knowledge of practice management and the

critical importance of the " front desk " .

Elmer Platz, PT

418 Route 515

Vernon, NJ 07462-3027

fax

http://www.platzpt.com

" Every man owes part of his time and money to the business or industry in

which he is engaged. No man has the moral right to withhold his support from

an organization that is striving to improve conditions within his sphere. "

President Theodore Roosevelt

Re: Coverage Issues

In a message dated 07/15/2000 3:13:37 PM Central Daylight Time,

ROHACK007@... writes:

<< The key is to be able to balance efficient business techniques with

quality care so our practicies may survive these difficult times.>>

Bob;

Very eloquently stated! Successful practices will need to partner with

their

business office staff and spend more time learning what is going on. The

weakest component of any clinic is not in the treatment area. Unless time

is

spent to learn and facilitate the front office, practices will continue to

struggle and some will fail. Therapists have continuing education

opportunities, but front office staff still suffer from the stereotype that

the best front office staff is one that accepts minumum wage and understands

the success of a practice hinges on the quality of therapy provided. I

realize that my statements are controversial, but until practitioners devote

as much attention to the business side of their practice, they will continue

to suffer financially.

Okay, I'm out of the pulpit this Sunday morning.

Jim

Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

Rochester Michigan. Register at today.

Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details

LAMP Summit 2000. July 23-25, 2000 Register at .

Visit our EStore at www.RehabBusiness.com

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In a message dated 7/15/2000 8:08:42 PM Central Daylight Time,

flickingerpt@... writes:

<< if you are able to successfully rehab the patient with the ACL repair

using 4 total visits - >>

Just a thought here. I don't want anyone acting on this as I need to contact

a patent attorney in order finalize this concept. In order to accomodate the

HMO's I would propose a " Jiffy Lube " concept. Providers would purchase old

automotive garages and open up the treatment bays. Since time and money are

at a premium (emphasis added-tongue in cheek), patients could drive their car

into the bay. For HMO patients we could apply ice or heat (whichever the

tech feels is most appropriate). By accepting the credit card at the time of

drive through, insurers could pay for services at the time of the treatment.

I'm still working on how to treat the HMO patient if they need anything other

than a Hot/Cold pack though. Any ideas?

With a concept like this, I am sure I can drive therapists out of business

very soon.

A. Nonmus

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> I'm still working on how to treat the HMO patient if they need anything

other

> than a Hot/Cold pack though. Any ideas?

>

yes. treatment could consist of watching a video and taking a test. the pt

would also be given an HEP: a pamplet with glossy pictures. the 2nd session

would just be a follow up to make sure the pt still has the pamplet. A

total of two sessions and the pt would not even have to get out of his car.

By the way, the fact that the pt stays in his car may help reduce general

liability costs to the business.

Mike Hickey, PT

Re: Coverage Issues

> In a message dated 7/15/2000 8:08:42 PM Central Daylight Time,

> flickingerpt@... writes:

>

> << if you are able to successfully rehab the patient with the ACL repair

> using 4 total visits - >>

>

> Just a thought here. I don't want anyone acting on this as I need to

contact

> a patent attorney in order finalize this concept. In order to accomodate

the

> HMO's I would propose a " Jiffy Lube " concept. Providers would purchase

old

> automotive garages and open up the treatment bays. Since time and money

are

> at a premium (emphasis added-tongue in cheek), patients could drive their

car

> into the bay. For HMO patients we could apply ice or heat (whichever the

> tech feels is most appropriate). By accepting the credit card at the time

of

> drive through, insurers could pay for services at the time of the

treatment.

> I'm still working on how to treat the HMO patient if they need anything

other

> than a Hot/Cold pack though. Any ideas?

>

> With a concept like this, I am sure I can drive therapists out of business

> very soon.

> A. Nonmus

>

>

>

> Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

Rochester Michigan. Register at today.

> Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details

> LAMP Summit 2000. July 23-25, 2000 Register at .

> Visit our EStore at www.RehabBusiness.com

>

>

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Guest guest

Since you have quoted one small, incomplete line of my original post - would you

mind explaining your point? And properly

identify yourself so that I know to whom I am speaking. Thanks.

Ed Flickinger, PT, MBA

JHall49629@... wrote:

> In a message dated 7/15/2000 8:08:42 PM Central Daylight Time,

> flickingerpt@... writes:

>

> << if you are able to successfully rehab the patient with the ACL repair

> using 4 total visits - >>

>

> Just a thought here. I don't want anyone acting on this as I need to contact

> a patent attorney in order finalize this concept. In order to accomodate the

> HMO's I would propose a " Jiffy Lube " concept. Providers would purchase old

> automotive garages and open up the treatment bays. Since time and money are

> at a premium (emphasis added-tongue in cheek), patients could drive their car

> into the bay. For HMO patients we could apply ice or heat (whichever the

> tech feels is most appropriate). By accepting the credit card at the time of

> drive through, insurers could pay for services at the time of the treatment.

> I'm still working on how to treat the HMO patient if they need anything other

> than a Hot/Cold pack though. Any ideas?

>

> With a concept like this, I am sure I can drive therapists out of business

> very soon.

> A. Nonmus

>

> Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

Rochester Michigan. Register at today.

> Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details

> LAMP Summit 2000. July 23-25, 2000 Register at .

> Visit our EStore at www.RehabBusiness.com

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Ahh, drive through PT. Now we're talking!

Helene Rosen

>>> " Mike Hickey " 07/17/00 07:09PM >>>

> I'm still working on how to treat the HMO patient if they need anything

other

> than a Hot/Cold pack though. Any ideas?

>

yes. treatment could consist of watching a video and taking a test. the pt

would also be given an HEP: a pamplet with glossy pictures. the 2nd session

would just be a follow up to make sure the pt still has the pamplet. A

total of two sessions and the pt would not even have to get out of his car.

By the way, the fact that the pt stays in his car may help reduce general

liability costs to the business.

Mike Hickey, PT

Re: Coverage Issues

> In a message dated 7/15/2000 8:08:42 PM Central Daylight Time,

> flickingerpt@... writes:

>

> << if you are able to successfully rehab the patient with the ACL repair

> using 4 total visits - >>

>

> Just a thought here. I don't want anyone acting on this as I need to

contact

> a patent attorney in order finalize this concept. In order to accomodate

the

> HMO's I would propose a " Jiffy Lube " concept. Providers would purchase

old

> automotive garages and open up the treatment bays. Since time and money

are

> at a premium (emphasis added-tongue in cheek), patients could drive their

car

> into the bay. For HMO patients we could apply ice or heat (whichever the

> tech feels is most appropriate). By accepting the credit card at the time

of

> drive through, insurers could pay for services at the time of the

treatment.

> I'm still working on how to treat the HMO patient if they need anything

other

> than a Hot/Cold pack though. Any ideas?

>

> With a concept like this, I am sure I can drive therapists out of business

> very soon.

> A. Nonmus

>

>

>

> Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

Rochester Michigan. Register at today.

> Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details

> LAMP Summit 2000. July 23-25, 2000 Register at .

> Visit our EStore at www.RehabBusiness.com

>

>

Coming September 22,2000 - Helene Fearon on Coding and Reimbursement - Rochester

Michigan. Register at today.

Rehab Pro - The New Way...A Better Way to Rehab Success! Call for details (800)

540-0774

LAMP Summit 2000. July 23-25, 2000 Register at .

Visit our EStore at www.RehabBusiness.com

!

!

!

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Guest guest

Bob, Jim, & Elmer --

AMEN!

Dick Hillyer

Re: Coverage Issues

>

>

> In a message dated 07/15/2000 3:13:37 PM Central Daylight Time,

> ROHACK007@... writes:

>

> << The key is to be able to balance efficient business techniques

with

> quality care so our practicies may survive these difficult times.>>

>

> Bob;

>

> Very eloquently stated! Successful practices will need to partner

with

> their

> business office staff and spend more time learning what is going on.

The

> weakest component of any clinic is not in the treatment area. Unless

time

> is

> spent to learn and facilitate the front office, practices will

continue to

> struggle and some will fail. Therapists have continuing education

> opportunities, but front office staff still suffer from the stereotype

that

> the best front office staff is one that accepts minumum wage and

understands

> the success of a practice hinges on the quality of therapy provided.

I

> realize that my statements are controversial, but until practitioners

devote

> as much attention to the business side of their practice, they will

continue

> to suffer financially.

>

> Okay, I'm out of the pulpit this Sunday morning.

> Jim

>

>

>

> Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

> Rochester Michigan. Register at today.

> Rehab Pro - The New Way...A Better Way to Rehab Success! Call for

details

>

> LAMP Summit 2000. July 23-25, 2000 Register at .

> Visit our EStore at www.RehabBusiness.com

>

>

>

>

>

> Coming September 22,2000 - Helene Fearon on Coding and Reimbursement -

Rochester Michigan. Register at today.

> Rehab Pro - The New Way...A Better Way to Rehab Success! Call for

details

> LAMP Summit 2000. July 23-25, 2000 Register at .

> Visit our EStore at www.RehabBusiness.com

>

>

>

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