Re: Scheduling Medicare Patients

[Guest guest]

Rick is spot on here. While I understand Larry's position, it does leave

some critical components out of the discussion particularly when trying to

compare such disparate practice settings such as the military practice

setting and the civilian private practice setting.

In the aforementioned military setting neither the third party payer nor

what constitutes " professional services " into account. In that setting all

that inevitably matters is outcome and that is where accountability

typically ends.

In the civilian arena accountability extends much further and is governed

first by state practice act and then the rules of the third party payer.

While there can be no arguing that much of what some provider extenders can

provide can be useful and practical in the eventual outcome, the q

> Interesting discussion. From the thread of the original email, the

> person was not rebuffed. They were reminded that how you schedule and bill

> for patients is not just dependent on whether they are Medicare, it is

> dependent on all payers and the definition of CPT codes as developed by the

> American Medical Association.

>

> For those payers that pay on a per diem rate, you still bill them according

> to the AMA definition of the CPT codes based on the amount of time you

> provided the one-on-one care and/or supervised modalities. As long as your

> charges are above the per diem rate, you get the per diem rate. The

> definition of concurrent therapy does not exist outside of the SNF Part A

> for CMS and I have never seen it used in a non-Medicare payer policy.

>

> We keep talking about all of the CMS superimposed rules that other payers

> do not have. Yes, CMS requires physicians/NPP's to sign the POC. Guess what,

> so does Aetna and some state Medicaid plans. CMS does not allow the use of

> non-therapists and assistants time treating patients to be billed to them.

> Guess what, so do several BCBS and Medicaid plans as well as TriCare. In

> fact, TriCare does not allow assistants to treat their patients in the

> private practice setting. CMS does not limit you in how many units you can

> bill on a given day, how many modality codes you can bill on a give day,

> etc. Guess what, other payers do.

>

> CMS has an arbitrary therapy cap per year that can be bypassed with the sue

> of the KX modifier. Most other payers also have arbitrary limits on therapy

> coverage per calendar year that can't be bypassed with any special modifier.

> You have to get on the phone with the payer and try to get the extra

> coverage that the patient requires.

>

> Medicare has the " 8 minute rule " . Non-Medicare payers will follow the

> definition of " each 15 minutes " of which you must do a substantial portion

> to bill.

>

> CMS reimburses for self care, cognitive therapy, sensory integration, group

> therapy, and aquatic therapy, to name a few. Guess what, many other payers

> do nt reimburse for some or all of these codes.

>

> Medicare requires a Progress Report every 10 visits or 30 calendar days,

> whichever is less. Most payers recommend you do a Progress report, just do

> not mandate the timeframe for completion.

>

> I could go on, but I think I have said enough. To me, the definition of

> superimposed means one payer does it while no other payers do. I do not

> think CMS has as many superimposed rules as some people think when you look

> at all the other payers.

>

> I am interested to know who wants CMS rules and regulations applied to all

> payers. I know I do not want all of them. I would love to eliminate the

> certification and recertification requiremetn along with the " 8 minute

> rule " . I would like to see modifications to the use of students in the

> outpatient setting and the timeframe for Progress Reports change to just

> every 10 visits. My personal opinion is I do not think one-on-one treatment

> provided by aides is skilled and should be reimbursed by insurance payers.

> To me, the one-on-one to be skilled requires the clinical judgment

> (therapist) or clinical knowledge (therapist or assistant).

>

> Regarding payment, the Medicare program tends to be one of the better

> payers for my hospital and clients compared to rates that other payers are

> reimbursing.

>

> Sincerely,

>

>

> Rick Gawenda, PT

> President

> Section on Health Policy & Administration

> APTA

>

>

> >

> > From: bchacko71 <bchacko71@. ..<mailto: bchacko71% 40sbcglobal. net>>

> > Subject: RE: Scheduling Medicare Patients

> > To: PTManager@yahoogrou ps.com<mailto:PTManager%

<PTManager%25>40yahoogroups. com><mailto:PTManager% 40yahoogroups. com>

> > Date: Tuesday, February 17, 2009, 9:55 PM

> >

> > Dear Group,

> > How often do most of you schedule medicare patients for one

> therapists

> > schedule so that he can be compliant with medicare rules of

> providing

> > one on one care and also be productive in todays tough economic

> times?

> > How many patients can a therapist see in an 8 hour period and be

> > productive?

> > Do you find it difficult to have therapists complete their

> > documentation on the same day? What is the productivity standard

> that

> > is expected by most clinics? What kind of revenue should a therapist

> > generate in terms of his salary? Eg: Should a therapist generate

> three

> > or four times his salary?

> > Thank you all who will share their thoughts.

> > B. Chacko

> > Tricare Rehab Services

> >

> >

[Guest guest]

Sorry, was too quick on the click and my previous message was sent

prematurely. (No jokes here please)

Here is the message in its entirety:

Rick is spot on here. While I understand Larry's position, it does leave

some critical components out of the discussion particularly when trying to

compare such disparate practice settings such as the military practice

setting and the civilian private practice setting.

In the aforementioned military setting neither the third party payer nor

what constitutes " professional services " into account. In that setting all

that inevitably matters is outcome and that is where accountability

typically ends.

In the civilian arena accountability extends much further and is governed

first by state practice act and then the rules of the third party payer.

While there can be no arguing that much of what some provider extenders can

provide can be useful and practical in the eventual outcome, the question

remains what expectation should the payer, whether first or third party,

have regarding payment for the services provided. In my opinion it would be

unreasonable to charge for a professional service if the service in and of

itself is not professional, such as an extender providing oversight,

supervision etcetera which would clearly lack the necessity of judgment or

skill of a licensed provider.

However and getting hopefully to a middle ground between what I think Larry

is advocating and those he feels are looking for more restrictive

environments is that this does not preclude that the services of an

unlicensed extender should be provided without charge despite being

" uncovered " from the perspective of a third party payer. Personally I think

there is value here that some consumers might be be willing to shoulder

financially if they have a perceived need for such a service. If someone

" wants " supervision for what many might consider to be an exercise program

independent of the need for skilled care or instruction then it should be

their financial responsibility not that of a third party payer or at least

not at the same cost as if a skilled licensed provider were to provide it.

Or if someone wants to " use " my facility because of convenience, comfort or

personal desire, then perhaps a " facility use " charge that is " uncovered "

would be most apropos.

If we are going to advocate coverage for services that do not require the

education, skills or judgment of licensed provider then, we need to propose

a reimbursement schema that accounts for this service. The current one does

not and it is my opinion to expect the same payment irregardless of the who

is providing the service or the level of education, skill or judgment of

that provider is unreasonable. Also if we are going to expect payment for

what amounts to non-professional services from the third party community,

can we truly justify the costs to society at large because we would be

advocating that these services are worthy of our fellow society members

sharing in the financial responsibility for the provision of those services.

The current system of RVRBS reimbursement is based on the costs of providing

the service for a licensed provider, not an on the job trained extender. If

we were to move in this direction then the logical consequence will be a

reduction in the RVRBS values, and is that something that we really want to

entertain?

At the end of the day, I think what has been advocated by Larry has some

merit, I personally just think that will be an incredibly tough sell based

on what I've discussed above. However, I also think that there is some

value in the use of extenders in certain cases, I just don't think it rises

to the point of meeting the need for third party payment responsibility.

Personal financial responsibility does have some role to play here though

and I think that is something to consider.

Mark Schwall, PT

Toms River, NJ

> Mark,

>

> It appears your entire reply was cut off. What was the rest of your

> response?

>

> Rick

>

>

>

>

> > >

> > > From: bchacko71 <bchacko71@. ..<mailto: bchacko71% 40sbcglobal. net>>

> > > Subject: RE: Scheduling Medicare Patients

> > > To: PTManager@yahoogrou ps.com<mailto: PTManager% <PTManager%25>

> 40yahoogroups. com><mailto: PTManager% 40yahoogroups. com>

>

> > > Date: Tuesday, February 17, 2009, 9:55 PM

> > >

> > > Dear Group,

> > > How often do most of you schedule medicare patients for one

> > therapists

> > > schedule so that he can be compliant with medicare rules of

> > providing

> > > one on one care and also be productive in todays tough economic

> > times?

> > > How many patients can a therapist see in an 8 hour period and be

> > > productive?

> > > Do you find it difficult to have therapists complete their

> > > documentation on the same day? What is the productivity standard

> > that

> > > is expected by most clinics? What kind of revenue should a therapist

> > > generate in terms of his salary? Eg: Should a therapist generate

> > three

> > > or four times his salary?

> > > Thank you all who will share their thoughts.

> > > B. Chacko

> > > Tricare Rehab Services

> > >

> > >

[Guest guest]

There are payers who pay a per diem rate and do require billing following AMA

guidelines. To make a generic statement that they do not could be costly for

providers. You keep mentioning Medicare is not the answer to standardize

documentation and billing. Who is saying it is? Not me. Not APTA. There are

going to be rules and regs for every payer. We either memorize all of them or

work as an organization to standardize them for the benefit of all involved. If

you are frustrated now, wait until outcome measures arrive.

Rick Gawenda, PT

President/CEO

Gawenda Seminars

http://www.gawendaseminars.com

Rick

Your examples support my point-payor plans are all over the map. Your point

regarding the requirement to bill using AMA CPT codes for per diem is not

correct-unless the contract spells it out and most that are on those types of

arrangements do not in my experience. Ironically, most of the cap contracts do

require. Bottom line is that it is a fragmented billing world and this is

problematic-the cure is not adoption of medicare as standard.

____________________________________

Larry

Larry Benz

13000 Equity Place Suite 105

Louisville, KY 40223

This message, including any attachments, contains confidential information

intended for a specific individual and purpose.

________________________________

From: PTManager <PTManager >

To: PTManager <PTManager >

Sent: Mon Feb 23 07:20:07 2009

Subject: RE: Re: Scheduling Medicare Patients

Interesting discussion. From the thread of the original email, the person was

not rebuffed. They were reminded that how you schedule and bill for patients is

not just dependent on whether they are Medicare, it is dependent on all payers

and the definition of CPT codes as developed by the American Medical

Association.

For those payers that pay on a per diem rate, you still bill them according to

the AMA definition of the CPT codes based on the amount of time you provided the

one-on-one care and/or supervised modalities. As long as your charges are above

the per diem rate, you get the per diem rate. The definition of concurrent

therapy does not exist outside of the SNF Part A for CMS and I have never seen

it used in a non-Medicare payer policy.

We keep talking about all of the CMS superimposed rules that other payers do not

have. Yes, CMS requires physicians/NPP's to sign the POC. Guess what, so does

Aetna and some state Medicaid plans. CMS does not allow the use of

non-therapists and assistants time treating patients to be billed to them. Guess

what, so do several BCBS and Medicaid plans as well as TriCare. In fact, TriCare

does not allow assistants to treat their patients in the private practice

setting. CMS does not limit you in how many units you can bill on a given day,

how many modality codes you can bill on a give day, etc. Guess what, other

payers do.

CMS has an arbitrary therapy cap per year that can be bypassed with the sue of

the KX modifier. Most other payers also have arbitrary limits on therapy

coverage per calendar year that can't be bypassed with any special modifier. You

have to get on the phone with the payer and try to get the extra coverage that

the patient requires.

Medicare has the " 8 minute rule " . Non-Medicare payers will follow the definition

of " each 15 minutes " of which you must do a substantial portion to bill.

CMS reimburses for self care, cognitive therapy, sensory integration, group

therapy, and aquatic therapy, to name a few. Guess what, many other payers do nt

reimburse for some or all of these codes.

Medicare requires a Progress Report every 10 visits or 30 calendar days,

whichever is less. Most payers recommend you do a Progress report, just do not

mandate the timeframe for completion.

I could go on, but I think I have said enough. To me, the definition of

superimposed means one payer does it while no other payers do. I do not think

CMS has as many superimposed rules as some people think when you look at all the

other payers.

I am interested to know who wants CMS rules and regulations applied to all

payers. I know I do not want all of them. I would love to eliminate the

certification and recertification requiremetn along with the " 8 minute rule " . I

would like to see modifications to the use of students in the outpatient setting

and the timeframe for Progress Reports change to just every 10 visits. My

personal opinion is I do not think one-on-one treatment provided by aides is

skilled and should be reimbursed by insurance payers. To me, the one-on-one to

be skilled requires the clinical judgment (therapist) or clinical knowledge

(therapist or assistant).

Regarding payment, the Medicare program tends to be one of the better payers for

my hospital and clients compared to rates that other payers are reimbursing.

Sincerely,

Rick Gawenda, PT

President

Section on Health Policy & Administration

APTA

>

> From: bchacko71 <bchacko71@. ..<mailto: bchacko71% 40sbcglobal. net>>

> Subject: RE: Scheduling Medicare Patients

> To: PTManager@yahoogrou ps.com<mailto:PTManager% 40yahoogroups. com><mailto:

PTManager% 40yahoogroups. com>

> Date: Tuesday, February 17, 2009, 9:55 PM

>

> Dear Group,

> How often do most of you schedule medicare patients for one

therapists

> schedule so that he can be compliant with medicare rules of

providing

> one on one care and also be productive in todays tough economic

times?

> How many patients can a therapist see in an 8 hour period and be

> productive?

> Do you find it difficult to have therapists complete their

> documentation on the same day? What is the productivity standard

that

> is expected by most clinics? What kind of revenue should a therapist

> generate in terms of his salary? Eg: Should a therapist generate

three

> or four times his salary?

> Thank you all who will share their thoughts.

> B. Chacko

> Tricare Rehab Services

>

>

[Guest guest]

Rick and Mark:

Rick, you are absolutely correct, the point is you can't generalize on payor

contracts-some per diems certainly do have you follow AMA CPT codes but I would

personally never sign one that did since it is counter to the whole concept. I

understand you are not fighting for medicare as standard-wish I could say the

same thing about others who confuse the whole " skilled " adjective with meaning

that all components of a PT intervention take some level of functioning only

possible thru licensure. Last I looked, it was a PT program I attended, not a

Skilled PT Program.

Mark, you are really going to have to explain yourself in regards to your

military explanation. Military PT's have to be licensed by the state and no

" ......professional services into account " surely you jest.

Perhaps some of our military PT's can chimb in. From my standpoint, it is the

ideal model and it is what we ought to be fighting for.

__________________________________________

Larry Benz PT, DPT

CONFIDENTIALITY This message is " Off The Record " . A lot of fancy legal speak

that none of us reads or understands if often contained here.

From: PTManager [mailto:PTManager ] On Behalf Of

Mark Schwall

Sent: Monday, February 23, 2009 2:54 PM

To: Rick Gawenda; ptmanager

Subject: Re: Re: Scheduling Medicare Patients

Sorry, was too quick on the click and my previous message was sent

prematurely. (No jokes here please)

Here is the message in its entirety:

Rick is spot on here. While I understand Larry's position, it does leave

some critical components out of the discussion particularly when trying to

compare such disparate practice settings such as the military practice

setting and the civilian private practice setting.

In the aforementioned military setting neither the third party payer nor

what constitutes " professional services " into account. In that setting all

that inevitably matters is outcome and that is where accountability

typically ends.

In the civilian arena accountability extends much further and is governed

first by state practice act and then the rules of the third party payer.

While there can be no arguing that much of what some provider extenders can

provide can be useful and practical in the eventual outcome, the question

remains what expectation should the payer, whether first or third party,

have regarding payment for the services provided. In my opinion it would be

unreasonable to charge for a professional service if the service in and of

itself is not professional, such as an extender providing oversight,

supervision etcetera which would clearly lack the necessity of judgment or

skill of a licensed provider.

However and getting hopefully to a middle ground between what I think Larry

is advocating and those he feels are looking for more restrictive

environments is that this does not preclude that the services of an

unlicensed extender should be provided without charge despite being

" uncovered " from the perspective of a third party payer. Personally I think

there is value here that some consumers might be be willing to shoulder

financially if they have a perceived need for such a service. If someone

" wants " supervision for what many might consider to be an exercise program

independent of the need for skilled care or instruction then it should be

their financial responsibility not that of a third party payer or at least

not at the same cost as if a skilled licensed provider were to provide it.

Or if someone wants to " use " my facility because of convenience, comfort or

personal desire, then perhaps a " facility use " charge that is " uncovered "

would be most apropos.

If we are going to advocate coverage for services that do not require the

education, skills or judgment of licensed provider then, we need to propose

a reimbursement schema that accounts for this service. The current one does

not and it is my opinion to expect the same payment irregardless of the who

is providing the service or the level of education, skill or judgment of

that provider is unreasonable. Also if we are going to expect payment for

what amounts to non-professional services from the third party community,

can we truly justify the costs to society at large because we would be

advocating that these services are worthy of our fellow society members

sharing in the financial responsibility for the provision of those services.

The current system of RVRBS reimbursement is based on the costs of providing

the service for a licensed provider, not an on the job trained extender. If

we were to move in this direction then the logical consequence will be a

reduction in the RVRBS values, and is that something that we really want to

entertain?

At the end of the day, I think what has been advocated by Larry has some

merit, I personally just think that will be an incredibly tough sell based

on what I've discussed above. However, I also think that there is some

value in the use of extenders in certain cases, I just don't think it rises

to the point of meeting the need for third party payment responsibility.

Personal financial responsibility does have some role to play here though

and I think that is something to consider.

Mark Schwall, PT

Toms River, NJ

On Mon, Feb 23, 2009 at 2:12 PM, Rick Gawenda

<rick0905@...<mailto:rick0905%40yahoo.com>> wrote:

> Mark,

>

> It appears your entire reply was cut off. What was the rest of your

> response?

>

> Rick

>

>

>

>

> > >

> > > From: bchacko71 <bchacko71@. ..<mailto: bchacko71% 40sbcglobal. net>>

> > > Subject: RE: Scheduling Medicare Patients

> > > To: PTManager@yahoogrou ps.com<mailto: PTManager% <PTManager%25>

> 40yahoogroups. com><mailto: PTManager% 40yahoogroups. com>

>

> > > Date: Tuesday, February 17, 2009, 9:55 PM

> > >

> > > Dear Group,

> > > How often do most of you schedule medicare patients for one

> > therapists

> > > schedule so that he can be compliant with medicare rules of

> > providing

> > > one on one care and also be productive in todays tough economic

> > times?

> > > How many patients can a therapist see in an 8 hour period and be

> > > productive?

> > > Do you find it difficult to have therapists complete their

> > > documentation on the same day? What is the productivity standard

> > that

> > > is expected by most clinics? What kind of revenue should a therapist

> > > generate in terms of his salary? Eg: Should a therapist generate

> > three

> > > or four times his salary?

> > > Thank you all who will share their thoughts.

> > > B. Chacko

> > > Tricare Rehab Services

> > >

> > >

[Guest guest]

Rick and Mark:

Rick, you are absolutely correct, the point is you can't generalize on payor

contracts-some per diems certainly do have you follow AMA CPT codes but I would

personally never sign one that did since it is counter to the whole concept. I

understand you are not fighting for medicare as standard-wish I could say the

same thing about others who confuse the whole " skilled " adjective with meaning

that all components of a PT intervention take some level of functioning only

possible thru licensure. Last I looked, it was a PT program I attended, not a

Skilled PT Program.

Mark, you are really going to have to explain yourself in regards to your

military explanation. Military PT's have to be licensed by the state and no

" ......professional services into account " surely you jest.

Perhaps some of our military PT's can chimb in. From my standpoint, it is the

ideal model and it is what we ought to be fighting for.

__________________________________________

Larry Benz PT, DPT

CONFIDENTIALITY This message is " Off The Record " . A lot of fancy legal speak

that none of us reads or understands if often contained here.

From: PTManager [mailto:PTManager ] On Behalf Of

Mark Schwall

Sent: Monday, February 23, 2009 2:54 PM

To: Rick Gawenda; ptmanager

Subject: Re: Re: Scheduling Medicare Patients

Sorry, was too quick on the click and my previous message was sent

prematurely. (No jokes here please)

Here is the message in its entirety:

Rick is spot on here. While I understand Larry's position, it does leave

some critical components out of the discussion particularly when trying to

compare such disparate practice settings such as the military practice

setting and the civilian private practice setting.

In the aforementioned military setting neither the third party payer nor

what constitutes " professional services " into account. In that setting all

that inevitably matters is outcome and that is where accountability

typically ends.

In the civilian arena accountability extends much further and is governed

first by state practice act and then the rules of the third party payer.

While there can be no arguing that much of what some provider extenders can

provide can be useful and practical in the eventual outcome, the question

remains what expectation should the payer, whether first or third party,

have regarding payment for the services provided. In my opinion it would be

unreasonable to charge for a professional service if the service in and of

itself is not professional, such as an extender providing oversight,

supervision etcetera which would clearly lack the necessity of judgment or

skill of a licensed provider.

However and getting hopefully to a middle ground between what I think Larry

is advocating and those he feels are looking for more restrictive

environments is that this does not preclude that the services of an

unlicensed extender should be provided without charge despite being

" uncovered " from the perspective of a third party payer. Personally I think

there is value here that some consumers might be be willing to shoulder

financially if they have a perceived need for such a service. If someone

" wants " supervision for what many might consider to be an exercise program

independent of the need for skilled care or instruction then it should be

their financial responsibility not that of a third party payer or at least

not at the same cost as if a skilled licensed provider were to provide it.

Or if someone wants to " use " my facility because of convenience, comfort or

personal desire, then perhaps a " facility use " charge that is " uncovered "

would be most apropos.

If we are going to advocate coverage for services that do not require the

education, skills or judgment of licensed provider then, we need to propose

a reimbursement schema that accounts for this service. The current one does

not and it is my opinion to expect the same payment irregardless of the who

is providing the service or the level of education, skill or judgment of

that provider is unreasonable. Also if we are going to expect payment for

what amounts to non-professional services from the third party community,

can we truly justify the costs to society at large because we would be

advocating that these services are worthy of our fellow society members

sharing in the financial responsibility for the provision of those services.

The current system of RVRBS reimbursement is based on the costs of providing

the service for a licensed provider, not an on the job trained extender. If

we were to move in this direction then the logical consequence will be a

reduction in the RVRBS values, and is that something that we really want to

entertain?

At the end of the day, I think what has been advocated by Larry has some

merit, I personally just think that will be an incredibly tough sell based

on what I've discussed above. However, I also think that there is some

value in the use of extenders in certain cases, I just don't think it rises

to the point of meeting the need for third party payment responsibility.

Personal financial responsibility does have some role to play here though

and I think that is something to consider.

Mark Schwall, PT

Toms River, NJ

On Mon, Feb 23, 2009 at 2:12 PM, Rick Gawenda

<rick0905@...<mailto:rick0905%40yahoo.com>> wrote:

> Mark,

>

> It appears your entire reply was cut off. What was the rest of your

> response?

>

> Rick

>

>

>

>

> > >

> > > From: bchacko71 <bchacko71@. ..<mailto: bchacko71% 40sbcglobal. net>>

> > > Subject: RE: Scheduling Medicare Patients

> > > To: PTManager@yahoogrou ps.com<mailto: PTManager% <PTManager%25>

> 40yahoogroups. com><mailto: PTManager% 40yahoogroups. com>

>

> > > Date: Tuesday, February 17, 2009, 9:55 PM

> > >

> > > Dear Group,

> > > How often do most of you schedule medicare patients for one

> > therapists

> > > schedule so that he can be compliant with medicare rules of

> > providing

> > > one on one care and also be productive in todays tough economic

> > times?

> > > How many patients can a therapist see in an 8 hour period and be

> > > productive?

> > > Do you find it difficult to have therapists complete their

> > > documentation on the same day? What is the productivity standard

> > that

> > > is expected by most clinics? What kind of revenue should a therapist

> > > generate in terms of his salary? Eg: Should a therapist generate

> > three

> > > or four times his salary?

> > > Thank you all who will share their thoughts.

> > > B. Chacko

> > > Tricare Rehab Services

> > >

> > >

[Guest guest]

Larry,

I am finding the " Scheduling Medicare Patients " thread to be very

interesting, but your post below caught my attention. I believe I

understand what you are saying in relation to the military model being the

best because of the following features it has:

1. Direct access (if you are certified through the military's program)

2. Professional autonomy

3. Ability to order some tests and medications

4. Professional recognition

However, based on my knowledge of the military system (and I admit it is not

much), it is a government run healthcare system. The PT's are not

practicing in private practice, they are working for the government. It

resembles a staff HMO from the perspective that the insurer (the government)

owns everything and employs everyone. The military can then establish

whatever rules they want and everyone has to abide by them.

Based on your other posts, I assume this ownership aspect (or lack thereof)

is not what you are advocating for but rather it is the direct access,

autonomy, etc., correct? I just want to be sure I understand what you are

advocating for. Thanks!

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

Olathe, Kansas

markdwyer87@...

Re: Scheduling Medicare Patients

Posted by: " Larry Benz " larry@... KortPT

Mon Feb 23, 2009 4:08 pm (PST)

Rick and Mark:

Rick, you are absolutely correct, the point is you can't generalize on payor

contracts-some per diems certainly do have you follow AMA CPT codes but I

would personally never sign one that did since it is counter to the whole

concept. I understand you are not fighting for medicare as standard-wish I

could say the same thing about others who confuse the whole " skilled "

adjective with meaning that all components of a PT intervention take some

level of functioning only possible thru licensure. Last I looked, it was a

PT program I attended, not a Skilled PT Program.

Mark, you are really going to have to explain yourself in regards to your

military explanation. Military PT's have to be licensed by the state and no

" ......professional services into account " surely you jest.

Perhaps some of our military PT's can chimb in. From my standpoint, it is

the ideal model and it is what we ought to be fighting for.

__________________________________________

Larry Benz PT, DPT

[Guest guest]

Larry,

I am finding the " Scheduling Medicare Patients " thread to be very

interesting, but your post below caught my attention. I believe I

understand what you are saying in relation to the military model being the

best because of the following features it has:

1. Direct access (if you are certified through the military's program)

2. Professional autonomy

3. Ability to order some tests and medications

4. Professional recognition

However, based on my knowledge of the military system (and I admit it is not

much), it is a government run healthcare system. The PT's are not

practicing in private practice, they are working for the government. It

resembles a staff HMO from the perspective that the insurer (the government)

owns everything and employs everyone. The military can then establish

whatever rules they want and everyone has to abide by them.

Based on your other posts, I assume this ownership aspect (or lack thereof)

is not what you are advocating for but rather it is the direct access,

autonomy, etc., correct? I just want to be sure I understand what you are

advocating for. Thanks!

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

Olathe, Kansas

markdwyer87@...

Re: Scheduling Medicare Patients

Posted by: " Larry Benz " larry@... KortPT

Mon Feb 23, 2009 4:08 pm (PST)

Rick and Mark:

Rick, you are absolutely correct, the point is you can't generalize on payor

contracts-some per diems certainly do have you follow AMA CPT codes but I

would personally never sign one that did since it is counter to the whole

concept. I understand you are not fighting for medicare as standard-wish I

could say the same thing about others who confuse the whole " skilled "

adjective with meaning that all components of a PT intervention take some

level of functioning only possible thru licensure. Last I looked, it was a

PT program I attended, not a Skilled PT Program.

Mark, you are really going to have to explain yourself in regards to your

military explanation. Military PT's have to be licensed by the state and no

" ......professional services into account " surely you jest.

Perhaps some of our military PT's can chimb in. From my standpoint, it is

the ideal model and it is what we ought to be fighting for.

__________________________________________

Larry Benz PT, DPT

[Guest guest]

Larry,

I am finding the " Scheduling Medicare Patients " thread to be very

interesting, but your post below caught my attention. I believe I

understand what you are saying in relation to the military model being the

best because of the following features it has:

1. Direct access (if you are certified through the military's program)

2. Professional autonomy

3. Ability to order some tests and medications

4. Professional recognition

However, based on my knowledge of the military system (and I admit it is not

much), it is a government run healthcare system. The PT's are not

practicing in private practice, they are working for the government. It

resembles a staff HMO from the perspective that the insurer (the government)

owns everything and employs everyone. The military can then establish

whatever rules they want and everyone has to abide by them.

Based on your other posts, I assume this ownership aspect (or lack thereof)

is not what you are advocating for but rather it is the direct access,

autonomy, etc., correct? I just want to be sure I understand what you are

advocating for. Thanks!

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

Olathe, Kansas

markdwyer87@...

Re: Scheduling Medicare Patients

Posted by: " Larry Benz " larry@... KortPT

Mon Feb 23, 2009 4:08 pm (PST)

Rick and Mark:

Rick, you are absolutely correct, the point is you can't generalize on payor

contracts-some per diems certainly do have you follow AMA CPT codes but I

would personally never sign one that did since it is counter to the whole

concept. I understand you are not fighting for medicare as standard-wish I

could say the same thing about others who confuse the whole " skilled "

adjective with meaning that all components of a PT intervention take some

level of functioning only possible thru licensure. Last I looked, it was a

PT program I attended, not a Skilled PT Program.

Mark, you are really going to have to explain yourself in regards to your

military explanation. Military PT's have to be licensed by the state and no

" ......professional services into account " surely you jest.

Perhaps some of our military PT's can chimb in. From my standpoint, it is

the ideal model and it is what we ought to be fighting for.

__________________________________________

Larry Benz PT, DPT

[Guest guest]

Hi ,

In our neck of the woods in NC- the active duty have traditionally had no

copays, nor do the family members seen for care at the base clinic. Family

members seen at " downtown " clinics generally have a copay depending on their

plan type (IIRC there are 3 levels depending on duty status/family

member/retiree). It has been a few years, but I haven't heard of any changes.

Dee Daley, PT, DPT

Southern Pines, NC

I would also like to ask what cost the military PT pt's incur, do

they have to pay anything out of pocket or is the PT service a fully

covered benefit?

E. s, PT, DPT

**************A Good Credit Score is 700 or Above. See yours in just 2 easy

steps!

(http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?redir=http:%2\

F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%3D668072%26hmpgID

%3D62%26bcd%3DfebemailfooterNO62)

[Guest guest]

Hi ,

In our neck of the woods in NC- the active duty have traditionally had no

copays, nor do the family members seen for care at the base clinic. Family

members seen at " downtown " clinics generally have a copay depending on their

plan type (IIRC there are 3 levels depending on duty status/family

member/retiree). It has been a few years, but I haven't heard of any changes.

Dee Daley, PT, DPT

Southern Pines, NC

I would also like to ask what cost the military PT pt's incur, do

they have to pay anything out of pocket or is the PT service a fully

covered benefit?

E. s, PT, DPT

**************A Good Credit Score is 700 or Above. See yours in just 2 easy

steps!

(http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?redir=http:%2\

F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%3D668072%26hmpgID

%3D62%26bcd%3DfebemailfooterNO62)

[Guest guest]

Hi Mark,

My local colleagues remind me that while the military PTs have a huge degree

of professional respect and autonomy, they do not tend to practice as pure

direct access as we know it but as part of an early musculoskeletal primary

care continuum (that might not be true for the therapists embedded in active

combat type situations). The system doesn't necessarily parallel what most

folks are familiar with, and some of that detail can be lost in the " sound

bytes " of posts.

The PA or first responder generally triages all complaints directing all

musculoskeletal care through to PT and then PT determines if ortho/phys

medicine/podiatry needs to be involved, etc. When I worked with hospital

privileges

at the local base, the level of communication was great, respect was mutual

and recognition of PT ability was on par with any other member of the medical

staff.

Probably splitting a few hairs and this may not be universal, but wanted you

to know.

Dee Daley, PT, DPT

Southern Pines, NC

Larry,

I am finding the " Scheduling Medicare Patients " thread to be very

interesting, but your post below caught my attention. I believe I

understand what you are saying in relation to the military model being the

best because of the following features it has:

1. Direct access (if you are certified through the military's program)

2. Professional autonomy

3. Ability to order some tests and medications

4. Professional recognition

However, based on my knowledge of the military system (and I admit it is not

much), it is a government run healthcare system. The PT's are not

practicing in private practice, they are working for the government. It

resembles a staff HMO from the perspective that the insurer (the government)

owns everything and employs everyone. The military can then establish

whatever rules they want and everyone has to abide by them.

Based on your other posts, I assume this ownership aspect (or lack thereof)

is not what you are advocating for but rather it is the direct access,

autonomy, etc., correct? I just want to be sure I understand what you are

advocating for. Thanks!

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

Olathe, Kansas

_markdwyer87@markdwyer87_ (mailto:markdwyer87@...)

**************A Good Credit Score is 700 or Above. See yours in just 2 easy

steps!

(http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?redir=http:%2\

F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%3D668072%26hmpgID

%3D62%26bcd%3DfebemailfooterNO62)

[Guest guest]

Hi Mark,

My local colleagues remind me that while the military PTs have a huge degree

of professional respect and autonomy, they do not tend to practice as pure

direct access as we know it but as part of an early musculoskeletal primary

care continuum (that might not be true for the therapists embedded in active

combat type situations). The system doesn't necessarily parallel what most

folks are familiar with, and some of that detail can be lost in the " sound

bytes " of posts.

The PA or first responder generally triages all complaints directing all

musculoskeletal care through to PT and then PT determines if ortho/phys

medicine/podiatry needs to be involved, etc. When I worked with hospital

privileges

at the local base, the level of communication was great, respect was mutual

and recognition of PT ability was on par with any other member of the medical

staff.

Probably splitting a few hairs and this may not be universal, but wanted you

to know.

Dee Daley, PT, DPT

Southern Pines, NC

Larry,

I am finding the " Scheduling Medicare Patients " thread to be very

interesting, but your post below caught my attention. I believe I

understand what you are saying in relation to the military model being the

best because of the following features it has:

1. Direct access (if you are certified through the military's program)

2. Professional autonomy

3. Ability to order some tests and medications

4. Professional recognition

However, based on my knowledge of the military system (and I admit it is not

much), it is a government run healthcare system. The PT's are not

practicing in private practice, they are working for the government. It

resembles a staff HMO from the perspective that the insurer (the government)

owns everything and employs everyone. The military can then establish

whatever rules they want and everyone has to abide by them.

Based on your other posts, I assume this ownership aspect (or lack thereof)

is not what you are advocating for but rather it is the direct access,

autonomy, etc., correct? I just want to be sure I understand what you are

advocating for. Thanks!

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

Olathe, Kansas

_markdwyer87@markdwyer87_ (mailto:markdwyer87@...)

**************A Good Credit Score is 700 or Above. See yours in just 2 easy

steps!

(http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?redir=http:%2\

F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%3D668072%26hmpgID

%3D62%26bcd%3DfebemailfooterNO62)

[Guest guest]

I would also like to ask what cost the military PT pt's incur, do

they have to pay anything out of pocket or is the PT service a fully

covered benefit?

E. s, PT, DPT

Orthopedic Clinical Specialist

Fellow American Academy of Orthopedic Manual Physical Therapists

www.douglasspt.com

>

> Larry,

>

> I am finding the " Scheduling Medicare Patients " thread to be very

> interesting, but your post below caught my attention. I believe I

> understand what you are saying in relation to the military model

being the

> best because of the following features it has:

> 1. Direct access (if you are certified through the military's

program)

> 2. Professional autonomy

> 3. Ability to order some tests and medications

> 4. Professional recognition

>

> However, based on my knowledge of the military system (and I admit

it is not

> much), it is a government run healthcare system. The PT's are not

> practicing in private practice, they are working for the

government. It

> resembles a staff HMO from the perspective that the insurer (the

government)

> owns everything and employs everyone. The military can then

establish

> whatever rules they want and everyone has to abide by them.

>

> Based on your other posts, I assume this ownership aspect (or lack

thereof)

> is not what you are advocating for but rather it is the direct

access,

> autonomy, etc., correct? I just want to be sure I understand what

you are

> advocating for. Thanks!

>

> Mark Dwyer, PT, MHA

> Director of Rehabilitation Services

> Olathe Medical Center

> Olathe, Kansas

> markdwyer87@...

>

> Re: Scheduling Medicare Patients

> Posted by: " Larry Benz " larry@... KortPT

> Mon Feb 23, 2009 4:08 pm (PST)

> Rick and Mark:

>

> Rick, you are absolutely correct, the point is you can't

generalize on payor

> contracts-some per diems certainly do have you follow AMA CPT

codes but I

> would personally never sign one that did since it is counter to

the whole

> concept. I understand you are not fighting for medicare as

standard-wish I

> could say the same thing about others who confuse the

whole " skilled "

> adjective with meaning that all components of a PT intervention

take some

> level of functioning only possible thru licensure. Last I looked,

it was a

> PT program I attended, not a Skilled PT Program.

>

> Mark, you are really going to have to explain yourself in regards

to your

> military explanation. Military PT's have to be licensed by the

state and no

> " ......professional services into account " surely you jest.

>

> Perhaps some of our military PT's can chimb in. From my

standpoint, it is

> the ideal model and it is what we ought to be fighting for.

>

> __________________________________________

> Larry Benz PT, DPT

>

[Guest guest]

In the military there is no co pay or out of pocket expense for the pt, at

least that is how is used to be.

CRMCw-ColSm

Jeff Nolder, MSPT

Director of Physical Medicine and Rehab

Cherokee Regional Medical Center

(fax)

From: PTManager [mailto:PTManager ] On Behalf

Of s

Sent: Wednesday, February 25, 2009 11:39 AM

To: PTManager

Subject: Re: Scheduling Medicare Patients

I would also like to ask what cost the military PT pt's incur, do

they have to pay anything out of pocket or is the PT service a fully

covered benefit?

E. s, PT, DPT

Orthopedic Clinical Specialist

Fellow American Academy of Orthopedic Manual Physical Therapists

www.douglasspt.com

>

> Larry,

>

> I am finding the " Scheduling Medicare Patients " thread to be very

> interesting, but your post below caught my attention. I believe I

> understand what you are saying in relation to the military model

being the

> best because of the following features it has:

> 1. Direct access (if you are certified through the military's

program)

> 2. Professional autonomy

> 3. Ability to order some tests and medications

> 4. Professional recognition

>

> However, based on my knowledge of the military system (and I admit

it is not

> much), it is a government run healthcare system. The PT's are not

> practicing in private practice, they are working for the

government. It

> resembles a staff HMO from the perspective that the insurer (the

government)

> owns everything and employs everyone. The military can then

establish

> whatever rules they want and everyone has to abide by them.

>

> Based on your other posts, I assume this ownership aspect (or lack

thereof)

> is not what you are advocating for but rather it is the direct

access,

> autonomy, etc., correct? I just want to be sure I understand what

you are

> advocating for. Thanks!

>

> Mark Dwyer, PT, MHA

> Director of Rehabilitation Services

> Olathe Medical Center

> Olathe, Kansas

> markdwyer87@...

>

> Re: Scheduling Medicare Patients

> Posted by: " Larry Benz " larry@... KortPT

> Mon Feb 23, 2009 4:08 pm (PST)

> Rick and Mark:

>

> Rick, you are absolutely correct, the point is you can't

generalize on payor

> contracts-some per diems certainly do have you follow AMA CPT

codes but I

> would personally never sign one that did since it is counter to

the whole

> concept. I understand you are not fighting for medicare as

standard-wish I

> could say the same thing about others who confuse the

whole " skilled "

> adjective with meaning that all components of a PT intervention

take some

> level of functioning only possible thru licensure. Last I looked,

it was a

> PT program I attended, not a Skilled PT Program.

>

> Mark, you are really going to have to explain yourself in regards

to your

> military explanation. Military PT's have to be licensed by the

state and no

> " ......professional services into account " surely you jest.

>

> Perhaps some of our military PT's can chimb in. From my

standpoint, it is

> the ideal model and it is what we ought to be fighting for.

>

> __________________________________________

> Larry Benz PT, DPT

>

[Guest guest]

Mark

Thanks for the question. I am advocating for practice environment and fighting

for unfettered direct access and elimination of any rules that fall outside of

state practice acts with the obvious exception of those standards of practice

that have withstood the vetting process of PT's (e.g. APTA practice standards).

I also completely buy into Vision 2020 which speaks to the ability for a doctor

of PT to determine the best interests of their patient versus a set of dumbed

down rules and procedures that reduce us to directed technicians and result in

the commodity perception where we end up with a huge lobby now wanting ATC's

equal access to medicare patients! The whole notion that all PT has to be 1 on 1

or " skilled " to be billed is ludicrous in my opinion. We don't hold MD's to that

same standard why should we PT " s? Going down a road to define skilled vs.

Non-skilled is a slippery slope. Again, we went to PT school not Skilled PT

school. An excellent point was made earlier about the government absolving

themselves from the rules they place on everyone else-like military PT.

I have made no exclusive claim on the ownership issue as I am not of the belief

that exclusive ownership and all PT " s are in private practice is ever realistic

or meaningful. I would rather strive for realistic goals and outcomes given

current health care debacle. We all claim that the current number of

underinsureds is too high-that would provide even more reason to move to a

military model for PT " s which is in part meant to serve a greater number of

patients with less resources by allowing PT's to make judgements as they were

trained and not constrained by superimposed rules.

Given a choice of seeing medicare (gov't) patients in a practice environment

where your time was spent with the patient and not consumed with 8 min rule,

plans of care/certification dates, paranoia of supervision/1-1 rules, units,

excessive documentation requirements timed vs untimed codes,etc. Which would you

choose?

____________________________________

Larry

Larry Benz

13000 Equity Place Suite 105

Louisville, KY 40223

This message, including any attachments, contains confidential information

intended for a specific individual and purpose.

________________________________

From: PTManager <PTManager >

To: PTManager <PTManager >

Sent: Wed Feb 25 16:20:17 2009

Subject: Re: Re: Scheduling Medicare Patients

Hi Mark,

My local colleagues remind me that while the military PTs have a huge degree

of professional respect and autonomy, they do not tend to practice as pure

direct access as we know it but as part of an early musculoskeletal primary

care continuum (that might not be true for the therapists embedded in active

combat type situations). The system doesn't necessarily parallel what most

folks are familiar with, and some of that detail can be lost in the " sound

bytes " of posts.

The PA or first responder generally triages all complaints directing all

musculoskeletal care through to PT and then PT determines if ortho/phys

medicine/podiatry needs to be involved, etc. When I worked with hospital

privileges

at the local base, the level of communication was great, respect was mutual

and recognition of PT ability was on par with any other member of the medical

staff.

Probably splitting a few hairs and this may not be universal, but wanted you

to know.

Dee Daley, PT, DPT

Southern Pines, NC

Larry,

I am finding the " Scheduling Medicare Patients " thread to be very

interesting, but your post below caught my attention. I believe I

understand what you are saying in relation to the military model being the

best because of the following features it has:

1. Direct access (if you are certified through the military's program)

2. Professional autonomy

3. Ability to order some tests and medications

4. Professional recognition

However, based on my knowledge of the military system (and I admit it is not

much), it is a government run healthcare system. The PT's are not

practicing in private practice, they are working for the government. It

resembles a staff HMO from the perspective that the insurer (the government)

owns everything and employs everyone. The military can then establish

whatever rules they want and everyone has to abide by them.

Based on your other posts, I assume this ownership aspect (or lack thereof)

is not what you are advocating for but rather it is the direct access,

autonomy, etc., correct? I just want to be sure I understand what you are

advocating for. Thanks!

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

Olathe, Kansas

_markdwyer87@markdwyer87_

(mailto:markdwyer87@...<mailto:markdwyer87%40comcast.net>)

**************A Good Credit Score is 700 or Above. See yours in just 2 easy

steps!

(http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?redir=http:%2\

F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%3D668072%26hmpgID

%3D62%26bcd%3DfebemailfooterNO62)

[Guest guest]

Mark

Thanks for the question. I am advocating for practice environment and fighting

for unfettered direct access and elimination of any rules that fall outside of

state practice acts with the obvious exception of those standards of practice

that have withstood the vetting process of PT's (e.g. APTA practice standards).

I also completely buy into Vision 2020 which speaks to the ability for a doctor

of PT to determine the best interests of their patient versus a set of dumbed

down rules and procedures that reduce us to directed technicians and result in

the commodity perception where we end up with a huge lobby now wanting ATC's

equal access to medicare patients! The whole notion that all PT has to be 1 on 1

or " skilled " to be billed is ludicrous in my opinion. We don't hold MD's to that

same standard why should we PT " s? Going down a road to define skilled vs.

Non-skilled is a slippery slope. Again, we went to PT school not Skilled PT

school. An excellent point was made earlier about the government absolving

themselves from the rules they place on everyone else-like military PT.

I have made no exclusive claim on the ownership issue as I am not of the belief

that exclusive ownership and all PT " s are in private practice is ever realistic

or meaningful. I would rather strive for realistic goals and outcomes given

current health care debacle. We all claim that the current number of

underinsureds is too high-that would provide even more reason to move to a

military model for PT " s which is in part meant to serve a greater number of

patients with less resources by allowing PT's to make judgements as they were

trained and not constrained by superimposed rules.

Given a choice of seeing medicare (gov't) patients in a practice environment

where your time was spent with the patient and not consumed with 8 min rule,

plans of care/certification dates, paranoia of supervision/1-1 rules, units,

excessive documentation requirements timed vs untimed codes,etc. Which would you

choose?

____________________________________

Larry

Larry Benz

13000 Equity Place Suite 105

Louisville, KY 40223

This message, including any attachments, contains confidential information

intended for a specific individual and purpose.

________________________________

From: PTManager <PTManager >

To: PTManager <PTManager >

Sent: Wed Feb 25 16:20:17 2009

Subject: Re: Re: Scheduling Medicare Patients

Hi Mark,

My local colleagues remind me that while the military PTs have a huge degree

of professional respect and autonomy, they do not tend to practice as pure

direct access as we know it but as part of an early musculoskeletal primary

care continuum (that might not be true for the therapists embedded in active

combat type situations). The system doesn't necessarily parallel what most

folks are familiar with, and some of that detail can be lost in the " sound

bytes " of posts.

The PA or first responder generally triages all complaints directing all

musculoskeletal care through to PT and then PT determines if ortho/phys

medicine/podiatry needs to be involved, etc. When I worked with hospital

privileges

at the local base, the level of communication was great, respect was mutual

and recognition of PT ability was on par with any other member of the medical

staff.

Probably splitting a few hairs and this may not be universal, but wanted you

to know.

Dee Daley, PT, DPT

Southern Pines, NC

Larry,

I am finding the " Scheduling Medicare Patients " thread to be very

interesting, but your post below caught my attention. I believe I

understand what you are saying in relation to the military model being the

best because of the following features it has:

1. Direct access (if you are certified through the military's program)

2. Professional autonomy

3. Ability to order some tests and medications

4. Professional recognition

However, based on my knowledge of the military system (and I admit it is not

much), it is a government run healthcare system. The PT's are not

practicing in private practice, they are working for the government. It

resembles a staff HMO from the perspective that the insurer (the government)

owns everything and employs everyone. The military can then establish

whatever rules they want and everyone has to abide by them.

Based on your other posts, I assume this ownership aspect (or lack thereof)

is not what you are advocating for but rather it is the direct access,

autonomy, etc., correct? I just want to be sure I understand what you are

advocating for. Thanks!

Mark Dwyer, PT, MHA

Director of Rehabilitation Services

Olathe Medical Center

Olathe, Kansas

_markdwyer87@markdwyer87_

(mailto:markdwyer87@...<mailto:markdwyer87%40comcast.net>)

**************A Good Credit Score is 700 or Above. See yours in just 2 easy

steps!

(http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?redir=http:%2\

F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%3D668072%26hmpgID

%3D62%26bcd%3DfebemailfooterNO62)

[Guest guest]

Larry,

you raise some great points and questions to be considered. The one

thing that keeps jumping into my mind is the reimbursement issue.

In the private practice world we are constantly trying to squeeze a

modest profit margin out of the constraints of reimbursement vs.

overhead including the high cost of recruitment and retainment of

PTs who can certainly find more money in settings other than private

practice. I wonder, in the military world, if we broke down the

cost of doing businesss and compared it to what real world practice

owners face on an everyday basis,are we comparing apples to apples

or apples to oarnges? In other words, would the military world

practice model be viable in the real world, would it be profitable

if the space to practice had to be leased and the PT's were free to

negotiate salaries and to practice in whatever setting they chose,

and if a constant supply of patients had to be earned in competition

with other private practices through outcomes and marketing?

E. s, PT, DPT

Orthopedic Cliical Specialist

Fellow American Academy of Orthopedic Manual Physical Therapists

www.douglasspt.com

>

> Mark

>

> Thanks for the question. I am advocating for practice environment

and fighting for unfettered direct access and elimination of any

rules that fall outside of state practice acts with the obvious

exception of those standards of practice that have withstood the

vetting process of PT's (e.g. APTA practice standards). I also

completely buy into Vision 2020 which speaks to the ability for a

doctor of PT to determine the best interests of their patient versus

a set of dumbed down rules and procedures that reduce us to directed

technicians and result in the commodity perception where we end up

with a huge lobby now wanting ATC's equal access to medicare

patients! The whole notion that all PT has to be 1 on 1 or " skilled "

to be billed is ludicrous in my opinion. We don't hold MD's to that

same standard why should we PT " s? Going down a road to define

skilled vs. Non-skilled is a slippery slope. Again, we went to PT

school not Skilled PT school. An excellent point was made earlier

about the government absolving themselves from the rules they place

on everyone else-like military PT.

>

> I have made no exclusive claim on the ownership issue as I am not

of the belief that exclusive ownership and all PT " s are in private

practice is ever realistic or meaningful. I would rather strive for

realistic goals and outcomes given current health care debacle. We

all claim that the current number of underinsureds is too high-that

would provide even more reason to move to a military model for PT " s

which is in part meant to serve a greater number of patients with

less resources by allowing PT's to make judgements as they were

trained and not constrained by superimposed rules.

>

> Given a choice of seeing medicare (gov't) patients in a practice

environment where your time was spent with the patient and not

consumed with 8 min rule, plans of care/certification dates,

paranoia of supervision/1-1 rules, units, excessive documentation

requirements timed vs untimed codes,etc. Which would you choose?

> ____________________________________

> Larry

>

> Larry Benz

> 13000 Equity Place Suite 105

> Louisville, KY 40223

>

> This message, including any attachments, contains confidential

information intended for a specific individual and purpose.

>

> ________________________________

> From: PTManager <PTManager >

> To: PTManager <PTManager >

> Sent: Wed Feb 25 16:20:17 2009

> Subject: Re: Re: Scheduling Medicare Patients

>

>

> Hi Mark,

>

> My local colleagues remind me that while the military PTs have a

huge degree

> of professional respect and autonomy, they do not tend to practice

as pure

> direct access as we know it but as part of an early

musculoskeletal primary

> care continuum (that might not be true for the therapists embedded

in active

> combat type situations). The system doesn't necessarily parallel

what most

> folks are familiar with, and some of that detail can be lost in

the " sound

> bytes " of posts.

>

> The PA or first responder generally triages all complaints

directing all

> musculoskeletal care through to PT and then PT determines if

ortho/phys

> medicine/podiatry needs to be involved, etc. When I worked with

hospital privileges

> at the local base, the level of communication was great, respect

was mutual

> and recognition of PT ability was on par with any other member of

the medical

> staff.

>

> Probably splitting a few hairs and this may not be universal, but

wanted you

> to know.

>

> Dee Daley, PT, DPT

> Southern Pines, NC

>

> Larry,

>

> I am finding the " Scheduling Medicare Patients " thread to be very

> interesting, but your post below caught my attention. I believe I

> understand what you are saying in relation to the military model

being the

> best because of the following features it has:

> 1. Direct access (if you are certified through the military's

program)

> 2. Professional autonomy

> 3. Ability to order some tests and medications

> 4. Professional recognition

>

> However, based on my knowledge of the military system (and I admit

it is not

> much), it is a government run healthcare system. The PT's are not

> practicing in private practice, they are working for the

government. It

> resembles a staff HMO from the perspective that the insurer (the

government)

> owns everything and employs everyone. The military can then

establish

> whatever rules they want and everyone has to abide by them.

>

> Based on your other posts, I assume this ownership aspect (or lack

thereof)

> is not what you are advocating for but rather it is the direct

access,

> autonomy, etc., correct? I just want to be sure I understand what

you are

> advocating for. Thanks!

>

> Mark Dwyer, PT, MHA

> Director of Rehabilitation Services

> Olathe Medical Center

> Olathe, Kansas

> _markdwyer87@markdwyer87_

(mailto:markdwyer87@...<mailto:markdwyer87%40comcast.net>)

>

> **************A Good Credit Score is 700 or Above. See yours in

just 2 easy

> steps!

> (http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?

redir=http:%2F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%

3D668072%26hmpgID

> %3D62%26bcd%3DfebemailfooterNO62)

>

>

[Guest guest]

's question to Larry, " would the military world practice model be viable in

the real world...? " leads one to ask, " What exactly is the 'real' world? "

Medical care is controlled by a virtual cabal of bureaucracies, each with its

own set of rules and regulations. The rules defines what service is, how much it

costs, who is eligible to give it, and who may receive it. Since neither

patients nor providers have direct control over any of that, when we compare

practice models, we are really comparing one unreal world with another.

Larry's notion that the PT practice act should be THE governor of practice is,

to me, extremely reasonable, albeit with the very important caveat that, should

a patient decide that he wants something else, he should have the freedom to go

and get it. That means not having to utilize, or pay for, only the services

deemed appropriate by the regulatory machines. Patients should, in other words,

be allowed to determine what PT is (by viewing our practice act!) and discussing

the service with a PT, and then decide if it is the route he wants to take.

(Likewise, if he decides he would rather see an ATC, or a chiropractor, or an

herbalist, or all three, fine.) That would be a very " real " world. It would also

encourage PTs and every other profession to begin to seriously study outcomes,

and seriously consider the most efficient way to produce those outcomes.

Dave Milano, PT, Director of Rehab Services

Laurel Health System

Re: Re: Scheduling Medicare Patients

>

>

> Hi Mark,

>

> My local colleagues remind me that while the military PTs have a

huge degree

> of professional respect and autonomy, they do not tend to practice

as pure

> direct access as we know it but as part of an early

musculoskeletal primary

> care continuum (that might not be true for the therapists embedded

in active

> combat type situations). The system doesn't necessarily parallel

what most

> folks are familiar with, and some of that detail can be lost in

the " sound

> bytes " of posts.

>

> The PA or first responder generally triages all complaints

directing all

> musculoskeletal care through to PT and then PT determines if

ortho/phys

> medicine/podiatry needs to be involved, etc. When I worked with

hospital privileges

> at the local base, the level of communication was great, respect

was mutual

> and recognition of PT ability was on par with any other member of

the medical

> staff.

>

> Probably splitting a few hairs and this may not be universal, but

wanted you

> to know.

>

> Dee Daley, PT, DPT

> Southern Pines, NC

>

> Larry,

>

> I am finding the " Scheduling Medicare Patients " thread to be very

> interesting, but your post below caught my attention. I believe I

> understand what you are saying in relation to the military model

being the

> best because of the following features it has:

> 1. Direct access (if you are certified through the military's

program)

> 2. Professional autonomy

> 3. Ability to order some tests and medications

> 4. Professional recognition

>

> However, based on my knowledge of the military system (and I admit

it is not

> much), it is a government run healthcare system. The PT's are not

> practicing in private practice, they are working for the

government. It

> resembles a staff HMO from the perspective that the insurer (the

government)

> owns everything and employs everyone. The military can then

establish

> whatever rules they want and everyone has to abide by them.

>

> Based on your other posts, I assume this ownership aspect (or lack

thereof)

> is not what you are advocating for but rather it is the direct

access,

> autonomy, etc., correct? I just want to be sure I understand what

you are

> advocating for. Thanks!

>

> Mark Dwyer, PT, MHA

> Director of Rehabilitation Services

> Olathe Medical Center

> Olathe, Kansas

> _markdwyer87@markdwyer87_

(mailto:markdwyer87@...<mailto:markdwyer87%40comcast.net>)

>

> **************A Good Credit Score is 700 or Above. See yours in

just 2 easy

> steps!

> (http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?

redir=http:%2F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%

3D668072%26hmpgID

> %3D62%26bcd%3DfebemailfooterNO62)

>

>

[Guest guest]

Larry,

Skilled physical therapy is worth defining (and documenting) if we

believe that we may someday get to use physician Evaluation &

Management Codes.

The codes are based on the complexity of decision-making and reimburse

at a higher level when you document more diagnoses, co-morbidities,

extra tests you need to order, etc.

Imagine a world where physical therapists are the front line

professionals to treat common problems like ankle sprains, lower back

pain and, perhaps, new-onset dizziness.

Maybe we would be restricted to just billing Level I or Level II E/M

codes.

We would be expected to refer any patient that presented with red

flags.

This idea may be futuristic but my point is that physicians DO have to

contend with their skilled services being questioned in Medicare

audits.

For example, an auditor might review a physician's chart and deny a

Level IV E/M code for " Insufficient Documentation " .

Docs I talk to get special training from consultants on how to

document their charges to support more complex level III and IV codes.

It seems that doctors have some of the same troubles as physical

therapists when it comes to describing what we do in our notes.

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...

> >

> > Mark

> >

> > Thanks for the question. I am advocating for practice environment

> and fighting for unfettered direct access and elimination of any

> rules that fall outside of state practice acts with the obvious

> exception of those standards of practice that have withstood the

> vetting process of PT's (e.g. APTA practice standards). I also

> completely buy into Vision 2020 which speaks to the ability for a

> doctor of PT to determine the best interests of their patient versus

> a set of dumbed down rules and procedures that reduce us to directed

> technicians and result in the commodity perception where we end up

> with a huge lobby now wanting ATC's equal access to medicare

> patients! The whole notion that all PT has to be 1 on 1 or " skilled "

> to be billed is ludicrous in my opinion. We don't hold MD's to that

> same standard why should we PT " s? Going down a road to define

> skilled vs. Non-skilled is a slippery slope. Again, we went to PT

> school not Skilled PT school. An excellent point was made earlier

> about the government absolving themselves from the rules they place

> on everyone else-like military PT.

> >

> > I have made no exclusive claim on the ownership issue as I am not

> of the belief that exclusive ownership and all PT " s are in private

> practice is ever realistic or meaningful. I would rather strive for

> realistic goals and outcomes given current health care debacle. We

> all claim that the current number of underinsureds is too high-that

> would provide even more reason to move to a military model for PT " s

> which is in part meant to serve a greater number of patients with

> less resources by allowing PT's to make judgements as they were

> trained and not constrained by superimposed rules.

> >

> > Given a choice of seeing medicare (gov't) patients in a practice

> environment where your time was spent with the patient and not

> consumed with 8 min rule, plans of care/certification dates,

> paranoia of supervision/1-1 rules, units, excessive documentation

> requirements timed vs untimed codes,etc. Which would you choose?

> > ____________________________________

> > Larry

> >

> > Larry Benz

> > 13000 Equity Place Suite 105

> > Louisville, KY 40223

> >

> > This message, including any attachments, contains confidential

> information intended for a specific individual and purpose.

> >

> > ________________________________

> > From: PTManager <PTManager >

> > To: PTManager <PTManager >

> > Sent: Wed Feb 25 16:20:17 2009

> > Subject: Re: Re: Scheduling Medicare Patients

> >

> >

> > Hi Mark,

> >

> > My local colleagues remind me that while the military PTs have a

> huge degree

> > of professional respect and autonomy, they do not tend to practice

> as pure

> > direct access as we know it but as part of an early

> musculoskeletal primary

> > care continuum (that might not be true for the therapists embedded

> in active

> > combat type situations). The system doesn't necessarily parallel

> what most

> > folks are familiar with, and some of that detail can be lost in

> the " sound

> > bytes " of posts.

> >

> > The PA or first responder generally triages all complaints

> directing all

> > musculoskeletal care through to PT and then PT determines if

> ortho/phys

> > medicine/podiatry needs to be involved, etc. When I worked with

> hospital privileges

> > at the local base, the level of communication was great, respect

> was mutual

> > and recognition of PT ability was on par with any other member of

> the medical

> > staff.

> >

> > Probably splitting a few hairs and this may not be universal, but

> wanted you

> > to know.

> >

> > Dee Daley, PT, DPT

> > Southern Pines, NC

> >

> > Larry,

> >

> > I am finding the " Scheduling Medicare Patients " thread to be very

> > interesting, but your post below caught my attention. I believe I

> > understand what you are saying in relation to the military model

> being the

> > best because of the following features it has:

> > 1. Direct access (if you are certified through the military's

> program)

> > 2. Professional autonomy

> > 3. Ability to order some tests and medications

> > 4. Professional recognition

> >

> > However, based on my knowledge of the military system (and I admit

> it is not

> > much), it is a government run healthcare system. The PT's are not

> > practicing in private practice, they are working for the

> government. It

> > resembles a staff HMO from the perspective that the insurer (the

> government)

> > owns everything and employs everyone. The military can then

> establish

> > whatever rules they want and everyone has to abide by them.

> >

> > Based on your other posts, I assume this ownership aspect (or lack

> thereof)

> > is not what you are advocating for but rather it is the direct

> access,

> > autonomy, etc., correct? I just want to be sure I understand what

> you are

> > advocating for. Thanks!

> >

> > Mark Dwyer, PT, MHA

> > Director of Rehabilitation Services

> > Olathe Medical Center

> > Olathe, Kansas

> > _markdwyer87@markdwyer87_

> (mailto:markdwyer87@<mailto:markdwyer87%40comcast.net>)

> >

> > **************A Good Credit Score is 700 or Above. See yours in

> just 2 easy

> > steps!

> >

(http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?

> redir=http:%2F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%

> 3D668072%26hmpgID

> > %3D62%26bcd%3DfebemailfooterNO62)

> >

> >

[Guest guest]

Larry,

Skilled physical therapy is worth defining (and documenting) if we

believe that we may someday get to use physician Evaluation &

Management Codes.

The codes are based on the complexity of decision-making and reimburse

at a higher level when you document more diagnoses, co-morbidities,

extra tests you need to order, etc.

Imagine a world where physical therapists are the front line

professionals to treat common problems like ankle sprains, lower back

pain and, perhaps, new-onset dizziness.

Maybe we would be restricted to just billing Level I or Level II E/M

codes.

We would be expected to refer any patient that presented with red

flags.

This idea may be futuristic but my point is that physicians DO have to

contend with their skilled services being questioned in Medicare

audits.

For example, an auditor might review a physician's chart and deny a

Level IV E/M code for " Insufficient Documentation " .

Docs I talk to get special training from consultants on how to

document their charges to support more complex level III and IV codes.

It seems that doctors have some of the same troubles as physical

therapists when it comes to describing what we do in our notes.

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...

> >

> > Mark

> >

> > Thanks for the question. I am advocating for practice environment

> and fighting for unfettered direct access and elimination of any

> rules that fall outside of state practice acts with the obvious

> exception of those standards of practice that have withstood the

> vetting process of PT's (e.g. APTA practice standards). I also

> completely buy into Vision 2020 which speaks to the ability for a

> doctor of PT to determine the best interests of their patient versus

> a set of dumbed down rules and procedures that reduce us to directed

> technicians and result in the commodity perception where we end up

> with a huge lobby now wanting ATC's equal access to medicare

> patients! The whole notion that all PT has to be 1 on 1 or " skilled "

> to be billed is ludicrous in my opinion. We don't hold MD's to that

> same standard why should we PT " s? Going down a road to define

> skilled vs. Non-skilled is a slippery slope. Again, we went to PT

> school not Skilled PT school. An excellent point was made earlier

> about the government absolving themselves from the rules they place

> on everyone else-like military PT.

> >

> > I have made no exclusive claim on the ownership issue as I am not

> of the belief that exclusive ownership and all PT " s are in private

> practice is ever realistic or meaningful. I would rather strive for

> realistic goals and outcomes given current health care debacle. We

> all claim that the current number of underinsureds is too high-that

> would provide even more reason to move to a military model for PT " s

> which is in part meant to serve a greater number of patients with

> less resources by allowing PT's to make judgements as they were

> trained and not constrained by superimposed rules.

> >

> > Given a choice of seeing medicare (gov't) patients in a practice

> environment where your time was spent with the patient and not

> consumed with 8 min rule, plans of care/certification dates,

> paranoia of supervision/1-1 rules, units, excessive documentation

> requirements timed vs untimed codes,etc. Which would you choose?

> > ____________________________________

> > Larry

> >

> > Larry Benz

> > 13000 Equity Place Suite 105

> > Louisville, KY 40223

> >

> > This message, including any attachments, contains confidential

> information intended for a specific individual and purpose.

> >

> > ________________________________

> > From: PTManager <PTManager >

> > To: PTManager <PTManager >

> > Sent: Wed Feb 25 16:20:17 2009

> > Subject: Re: Re: Scheduling Medicare Patients

> >

> >

> > Hi Mark,

> >

> > My local colleagues remind me that while the military PTs have a

> huge degree

> > of professional respect and autonomy, they do not tend to practice

> as pure

> > direct access as we know it but as part of an early

> musculoskeletal primary

> > care continuum (that might not be true for the therapists embedded

> in active

> > combat type situations). The system doesn't necessarily parallel

> what most

> > folks are familiar with, and some of that detail can be lost in

> the " sound

> > bytes " of posts.

> >

> > The PA or first responder generally triages all complaints

> directing all

> > musculoskeletal care through to PT and then PT determines if

> ortho/phys

> > medicine/podiatry needs to be involved, etc. When I worked with

> hospital privileges

> > at the local base, the level of communication was great, respect

> was mutual

> > and recognition of PT ability was on par with any other member of

> the medical

> > staff.

> >

> > Probably splitting a few hairs and this may not be universal, but

> wanted you

> > to know.

> >

> > Dee Daley, PT, DPT

> > Southern Pines, NC

> >

> > Larry,

> >

> > I am finding the " Scheduling Medicare Patients " thread to be very

> > interesting, but your post below caught my attention. I believe I

> > understand what you are saying in relation to the military model

> being the

> > best because of the following features it has:

> > 1. Direct access (if you are certified through the military's

> program)

> > 2. Professional autonomy

> > 3. Ability to order some tests and medications

> > 4. Professional recognition

> >

> > However, based on my knowledge of the military system (and I admit

> it is not

> > much), it is a government run healthcare system. The PT's are not

> > practicing in private practice, they are working for the

> government. It

> > resembles a staff HMO from the perspective that the insurer (the

> government)

> > owns everything and employs everyone. The military can then

> establish

> > whatever rules they want and everyone has to abide by them.

> >

> > Based on your other posts, I assume this ownership aspect (or lack

> thereof)

> > is not what you are advocating for but rather it is the direct

> access,

> > autonomy, etc., correct? I just want to be sure I understand what

> you are

> > advocating for. Thanks!

> >

> > Mark Dwyer, PT, MHA

> > Director of Rehabilitation Services

> > Olathe Medical Center

> > Olathe, Kansas

> > _markdwyer87@markdwyer87_

> (mailto:markdwyer87@<mailto:markdwyer87%40comcast.net>)

> >

> > **************A Good Credit Score is 700 or Above. See yours in

> just 2 easy

> > steps!

> >

(http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?

> redir=http:%2F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%

> 3D668072%26hmpgID

> > %3D62%26bcd%3DfebemailfooterNO62)

> >

> >

[Guest guest]

Tim:

I disagree. Adding " skilled " is redundant. Examination and determining

relative interventions are what we do-not any differently than a physician

acting within their scope of practice. Doesn't the idea of a " skilled "

physician or medical service appear to be irrelevant?

Your point on complexity and decision making is right on and relative to the E & M

codes simply because both an element of time and the amount of systems review

might be more exhaustive and therefore require more reimbursement. I am with

you on that one and believe we should fall within a framework on E & M. ly,

I don't think CPT codes represent physical therapy anymore-we shouldn't be

" timed " professional where issues such as " 8 minute " , " timed vs. untimed codes " ,

aggregating minutes, and pre/post treatment time are even an issue nor waist

time determining if " group " should have been charged or whether a mild overlap

suddenly transformed a manual therapy technique into " group therapy " (or should

I not charge the patient for warming up and therefore it is now a manual therapy

technique or wait a minute the overlap was a work comp patient so it doesn't

matter-illustrations only for purposes of demonstrating the idiocy of things we

have to do as PT'). Please don't take these scenarios and debate the different

nuances and how they could have been billed!

Perhaps one way to change the CPT code system is simply consolidate all of the

codes into an E & M type of system and let our documentation support the level of

E & M.

_____________________________

Larry Benz PT, DPT

From: PTManager [mailto:PTManager ] On Behalf Of

Sent: Friday, February 27, 2009 6:06 PM

To: PTManager

Subject: Re: Scheduling Medicare Patients

Larry,

Skilled physical therapy is worth defining (and documenting) if we

believe that we may someday get to use physician Evaluation &

Management Codes.

The codes are based on the complexity of decision-making and reimburse

at a higher level when you document more diagnoses, co-morbidities,

extra tests you need to order, etc.

Imagine a world where physical therapists are the front line

professionals to treat common problems like ankle sprains, lower back

pain and, perhaps, new-onset dizziness.

Maybe we would be restricted to just billing Level I or Level II E/M

codes.

We would be expected to refer any patient that presented with red

flags.

This idea may be futuristic but my point is that physicians DO have to

contend with their skilled services being questioned in Medicare

audits.

For example, an auditor might review a physician's chart and deny a

Level IV E/M code for " Insufficient Documentation " .

Docs I talk to get special training from consultants on how to

document their charges to support more complex level III and IV codes.

It seems that doctors have some of the same troubles as physical

therapists when it comes to describing what we do in our notes.

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...<mailto:TimRichPT%40PhysicalTherapyDiagnos\

is.com>

> >

> > Mark

> >

> > Thanks for the question. I am advocating for practice environment

> and fighting for unfettered direct access and elimination of any

> rules that fall outside of state practice acts with the obvious

> exception of those standards of practice that have withstood the

> vetting process of PT's (e.g. APTA practice standards). I also

> completely buy into Vision 2020 which speaks to the ability for a

> doctor of PT to determine the best interests of their patient versus

> a set of dumbed down rules and procedures that reduce us to directed

> technicians and result in the commodity perception where we end up

> with a huge lobby now wanting ATC's equal access to medicare

> patients! The whole notion that all PT has to be 1 on 1 or " skilled "

> to be billed is ludicrous in my opinion. We don't hold MD's to that

> same standard why should we PT " s? Going down a road to define

> skilled vs. Non-skilled is a slippery slope. Again, we went to PT

> school not Skilled PT school. An excellent point was made earlier

> about the government absolving themselves from the rules they place

> on everyone else-like military PT.

> >

> > I have made no exclusive claim on the ownership issue as I am not

> of the belief that exclusive ownership and all PT " s are in private

> practice is ever realistic or meaningful. I would rather strive for

> realistic goals and outcomes given current health care debacle. We

> all claim that the current number of underinsureds is too high-that

> would provide even more reason to move to a military model for PT " s

> which is in part meant to serve a greater number of patients with

> less resources by allowing PT's to make judgements as they were

> trained and not constrained by superimposed rules.

> >

> > Given a choice of seeing medicare (gov't) patients in a practice

> environment where your time was spent with the patient and not

> consumed with 8 min rule, plans of care/certification dates,

> paranoia of supervision/1-1 rules, units, excessive documentation

> requirements timed vs untimed codes,etc. Which would you choose?

> > ____________________________________

> > Larry

> >

> > Larry Benz

> > 13000 Equity Place Suite 105

> > Louisville, KY 40223

> >

> > This message, including any attachments, contains confidential

> information intended for a specific individual and purpose.

> >

> > ________________________________

> > From: PTManager <mailto:PTManager%40yahoogroups.com>

<PTManager <mailto:PTManager%40yahoogroups.com>>

> > To: PTManager <mailto:PTManager%40yahoogroups.com>

<PTManager <mailto:PTManager%40yahoogroups.com>>

> > Sent: Wed Feb 25 16:20:17 2009

> > Subject: Re: Re: Scheduling Medicare Patients

> >

> >

> > Hi Mark,

> >

> > My local colleagues remind me that while the military PTs have a

> huge degree

> > of professional respect and autonomy, they do not tend to practice

> as pure

> > direct access as we know it but as part of an early

> musculoskeletal primary

> > care continuum (that might not be true for the therapists embedded

> in active

> > combat type situations). The system doesn't necessarily parallel

> what most

> > folks are familiar with, and some of that detail can be lost in

> the " sound

> > bytes " of posts.

> >

> > The PA or first responder generally triages all complaints

> directing all

> > musculoskeletal care through to PT and then PT determines if

> ortho/phys

> > medicine/podiatry needs to be involved, etc. When I worked with

> hospital privileges

> > at the local base, the level of communication was great, respect

> was mutual

> > and recognition of PT ability was on par with any other member of

> the medical

> > staff.

> >

> > Probably splitting a few hairs and this may not be universal, but

> wanted you

> > to know.

> >

> > Dee Daley, PT, DPT

> > Southern Pines, NC

> >

> > Larry,

> >

> > I am finding the " Scheduling Medicare Patients " thread to be very

> > interesting, but your post below caught my attention. I believe I

> > understand what you are saying in relation to the military model

> being the

> > best because of the following features it has:

> > 1. Direct access (if you are certified through the military's

> program)

> > 2. Professional autonomy

> > 3. Ability to order some tests and medications

> > 4. Professional recognition

> >

> > However, based on my knowledge of the military system (and I admit

> it is not

> > much), it is a government run healthcare system. The PT's are not

> > practicing in private practice, they are working for the

> government. It

> > resembles a staff HMO from the perspective that the insurer (the

> government)

> > owns everything and employs everyone. The military can then

> establish

> > whatever rules they want and everyone has to abide by them.

> >

> > Based on your other posts, I assume this ownership aspect (or lack

> thereof)

> > is not what you are advocating for but rather it is the direct

> access,

> > autonomy, etc., correct? I just want to be sure I understand what

> you are

> > advocating for. Thanks!

> >

> > Mark Dwyer, PT, MHA

> > Director of Rehabilitation Services

> > Olathe Medical Center

> > Olathe, Kansas

> > _markdwyer87@markdwyer87_

> (mailto:markdwyer87@<mailto:markdwyer87%40comcast.net>)

> >

> > **************A Good Credit Score is 700 or Above. See yours in

> just 2 easy

> > steps!

> >

(http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?

> redir=http:%2F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%

> 3D668072%26hmpgID

> > %3D62%26bcd%3DfebemailfooterNO62)

> >

> >

[Guest guest]

Tim:

I disagree. Adding " skilled " is redundant. Examination and determining

relative interventions are what we do-not any differently than a physician

acting within their scope of practice. Doesn't the idea of a " skilled "

physician or medical service appear to be irrelevant?

Your point on complexity and decision making is right on and relative to the E & M

codes simply because both an element of time and the amount of systems review

might be more exhaustive and therefore require more reimbursement. I am with

you on that one and believe we should fall within a framework on E & M. ly,

I don't think CPT codes represent physical therapy anymore-we shouldn't be

" timed " professional where issues such as " 8 minute " , " timed vs. untimed codes " ,

aggregating minutes, and pre/post treatment time are even an issue nor waist

time determining if " group " should have been charged or whether a mild overlap

suddenly transformed a manual therapy technique into " group therapy " (or should

I not charge the patient for warming up and therefore it is now a manual therapy

technique or wait a minute the overlap was a work comp patient so it doesn't

matter-illustrations only for purposes of demonstrating the idiocy of things we

have to do as PT'). Please don't take these scenarios and debate the different

nuances and how they could have been billed!

Perhaps one way to change the CPT code system is simply consolidate all of the

codes into an E & M type of system and let our documentation support the level of

E & M.

_____________________________

Larry Benz PT, DPT

From: PTManager [mailto:PTManager ] On Behalf Of

Sent: Friday, February 27, 2009 6:06 PM

To: PTManager

Subject: Re: Scheduling Medicare Patients

Larry,

Skilled physical therapy is worth defining (and documenting) if we

believe that we may someday get to use physician Evaluation &

Management Codes.

The codes are based on the complexity of decision-making and reimburse

at a higher level when you document more diagnoses, co-morbidities,

extra tests you need to order, etc.

Imagine a world where physical therapists are the front line

professionals to treat common problems like ankle sprains, lower back

pain and, perhaps, new-onset dizziness.

Maybe we would be restricted to just billing Level I or Level II E/M

codes.

We would be expected to refer any patient that presented with red

flags.

This idea may be futuristic but my point is that physicians DO have to

contend with their skilled services being questioned in Medicare

audits.

For example, an auditor might review a physician's chart and deny a

Level IV E/M code for " Insufficient Documentation " .

Docs I talk to get special training from consultants on how to

document their charges to support more complex level III and IV codes.

It seems that doctors have some of the same troubles as physical

therapists when it comes to describing what we do in our notes.

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...<mailto:TimRichPT%40PhysicalTherapyDiagnos\

is.com>

> >

> > Mark

> >

> > Thanks for the question. I am advocating for practice environment

> and fighting for unfettered direct access and elimination of any

> rules that fall outside of state practice acts with the obvious

> exception of those standards of practice that have withstood the

> vetting process of PT's (e.g. APTA practice standards). I also

> completely buy into Vision 2020 which speaks to the ability for a

> doctor of PT to determine the best interests of their patient versus

> a set of dumbed down rules and procedures that reduce us to directed

> technicians and result in the commodity perception where we end up

> with a huge lobby now wanting ATC's equal access to medicare

> patients! The whole notion that all PT has to be 1 on 1 or " skilled "

> to be billed is ludicrous in my opinion. We don't hold MD's to that

> same standard why should we PT " s? Going down a road to define

> skilled vs. Non-skilled is a slippery slope. Again, we went to PT

> school not Skilled PT school. An excellent point was made earlier

> about the government absolving themselves from the rules they place

> on everyone else-like military PT.

> >

> > I have made no exclusive claim on the ownership issue as I am not

> of the belief that exclusive ownership and all PT " s are in private

> practice is ever realistic or meaningful. I would rather strive for

> realistic goals and outcomes given current health care debacle. We

> all claim that the current number of underinsureds is too high-that

> would provide even more reason to move to a military model for PT " s

> which is in part meant to serve a greater number of patients with

> less resources by allowing PT's to make judgements as they were

> trained and not constrained by superimposed rules.

> >

> > Given a choice of seeing medicare (gov't) patients in a practice

> environment where your time was spent with the patient and not

> consumed with 8 min rule, plans of care/certification dates,

> paranoia of supervision/1-1 rules, units, excessive documentation

> requirements timed vs untimed codes,etc. Which would you choose?

> > ____________________________________

> > Larry

> >

> > Larry Benz

> > 13000 Equity Place Suite 105

> > Louisville, KY 40223

> >

> > This message, including any attachments, contains confidential

> information intended for a specific individual and purpose.

> >

> > ________________________________

> > From: PTManager <mailto:PTManager%40yahoogroups.com>

<PTManager <mailto:PTManager%40yahoogroups.com>>

> > To: PTManager <mailto:PTManager%40yahoogroups.com>

<PTManager <mailto:PTManager%40yahoogroups.com>>

> > Sent: Wed Feb 25 16:20:17 2009

> > Subject: Re: Re: Scheduling Medicare Patients

> >

> >

> > Hi Mark,

> >

> > My local colleagues remind me that while the military PTs have a

> huge degree

> > of professional respect and autonomy, they do not tend to practice

> as pure

> > direct access as we know it but as part of an early

> musculoskeletal primary

> > care continuum (that might not be true for the therapists embedded

> in active

> > combat type situations). The system doesn't necessarily parallel

> what most

> > folks are familiar with, and some of that detail can be lost in

> the " sound

> > bytes " of posts.

> >

> > The PA or first responder generally triages all complaints

> directing all

> > musculoskeletal care through to PT and then PT determines if

> ortho/phys

> > medicine/podiatry needs to be involved, etc. When I worked with

> hospital privileges

> > at the local base, the level of communication was great, respect

> was mutual

> > and recognition of PT ability was on par with any other member of

> the medical

> > staff.

> >

> > Probably splitting a few hairs and this may not be universal, but

> wanted you

> > to know.

> >

> > Dee Daley, PT, DPT

> > Southern Pines, NC

> >

> > Larry,

> >

> > I am finding the " Scheduling Medicare Patients " thread to be very

> > interesting, but your post below caught my attention. I believe I

> > understand what you are saying in relation to the military model

> being the

> > best because of the following features it has:

> > 1. Direct access (if you are certified through the military's

> program)

> > 2. Professional autonomy

> > 3. Ability to order some tests and medications

> > 4. Professional recognition

> >

> > However, based on my knowledge of the military system (and I admit

> it is not

> > much), it is a government run healthcare system. The PT's are not

> > practicing in private practice, they are working for the

> government. It

> > resembles a staff HMO from the perspective that the insurer (the

> government)

> > owns everything and employs everyone. The military can then

> establish

> > whatever rules they want and everyone has to abide by them.

> >

> > Based on your other posts, I assume this ownership aspect (or lack

> thereof)

> > is not what you are advocating for but rather it is the direct

> access,

> > autonomy, etc., correct? I just want to be sure I understand what

> you are

> > advocating for. Thanks!

> >

> > Mark Dwyer, PT, MHA

> > Director of Rehabilitation Services

> > Olathe Medical Center

> > Olathe, Kansas

> > _markdwyer87@markdwyer87_

> (mailto:markdwyer87@<mailto:markdwyer87%40comcast.net>)

> >

> > **************A Good Credit Score is 700 or Above. See yours in

> just 2 easy

> > steps!

> >

(http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?

> redir=http:%2F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%

> 3D668072%26hmpgID

> > %3D62%26bcd%3DfebemailfooterNO62)

> >

> >

[Guest guest]

:

Tough to compare. The military health care model (not just PT) is in part set

up that way due to the vast numbers and limited resources. The leverage they

get is caused from absolving themselves of the myriad of regulations that the

government places on everyone else. Relative to PT, it obviously works as they

are more productive on a per therapist basis and the PT's in the military as a

percent have more board certified specialists (they get professional pay for

doing it) and have produced more research. I can't speak to clinical outcomes

vs. non-military as I am not familiar with any research to that effect.

I would think the financial modeling using this practice would be significantly

more profitable. The hidden cost of compliance, documentation time, coding,

regulations, etc. are an incredible financial burden to a practice. Based on

what I have seen in the marketplace, there are many reasons why PT's leave

outpatient practice (private or other). They include the enormous pressure of

the environment when you take into account productivity pressure, absurd

documentation requirements, compliance, coding, differentiating payor sources,

clinical excellence, customer service, downward reimbursement and the like. Why

put up with that when you can make more money in another setting and perhaps

have more flexibility? Speaking strictly from an environment standpoint,

outpatient setting is becoming the most unattractive of all in the PT world.

This is not to suggest that other settings don't have some aspects of these

" pressures " but it is clear that more seasoned PT's are exiting outpatient for

other settings rather than the opposite.

_____________________________

Larry Benz PT, DPT

From: PTManager [mailto:PTManager ] On Behalf Of

s

Sent: Friday, February 27, 2009 8:55 AM

To: PTManager

Subject: Re: Scheduling Medicare Patients

Larry,

you raise some great points and questions to be considered. The one

thing that keeps jumping into my mind is the reimbursement issue.

In the private practice world we are constantly trying to squeeze a

modest profit margin out of the constraints of reimbursement vs.

overhead including the high cost of recruitment and retainment of

PTs who can certainly find more money in settings other than private

practice. I wonder, in the military world, if we broke down the

cost of doing businesss and compared it to what real world practice

owners face on an everyday basis,are we comparing apples to apples

or apples to oarnges? In other words, would the military world

practice model be viable in the real world, would it be profitable

if the space to practice had to be leased and the PT's were free to

negotiate salaries and to practice in whatever setting they chose,

and if a constant supply of patients had to be earned in competition

with other private practices through outcomes and marketing?

E. s, PT, DPT

Orthopedic Cliical Specialist

Fellow American Academy of Orthopedic Manual Physical Therapists

www.douglasspt.com

>

> Mark

>

> Thanks for the question. I am advocating for practice environment

and fighting for unfettered direct access and elimination of any

rules that fall outside of state practice acts with the obvious

exception of those standards of practice that have withstood the

vetting process of PT's (e.g. APTA practice standards). I also

completely buy into Vision 2020 which speaks to the ability for a

doctor of PT to determine the best interests of their patient versus

a set of dumbed down rules and procedures that reduce us to directed

technicians and result in the commodity perception where we end up

with a huge lobby now wanting ATC's equal access to medicare

patients! The whole notion that all PT has to be 1 on 1 or " skilled "

to be billed is ludicrous in my opinion. We don't hold MD's to that

same standard why should we PT " s? Going down a road to define

skilled vs. Non-skilled is a slippery slope. Again, we went to PT

school not Skilled PT school. An excellent point was made earlier

about the government absolving themselves from the rules they place

on everyone else-like military PT.

>

> I have made no exclusive claim on the ownership issue as I am not

of the belief that exclusive ownership and all PT " s are in private

practice is ever realistic or meaningful. I would rather strive for

realistic goals and outcomes given current health care debacle. We

all claim that the current number of underinsureds is too high-that

would provide even more reason to move to a military model for PT " s

which is in part meant to serve a greater number of patients with

less resources by allowing PT's to make judgements as they were

trained and not constrained by superimposed rules.

>

> Given a choice of seeing medicare (gov't) patients in a practice

environment where your time was spent with the patient and not

consumed with 8 min rule, plans of care/certification dates,

paranoia of supervision/1-1 rules, units, excessive documentation

requirements timed vs untimed codes,etc. Which would you choose?

> ____________________________________

> Larry

>

> Larry Benz

> 13000 Equity Place Suite 105

> Louisville, KY 40223

>

> This message, including any attachments, contains confidential

information intended for a specific individual and purpose.

>

> ________________________________

> From: PTManager <mailto:PTManager%40yahoogroups.com>

<PTManager <mailto:PTManager%40yahoogroups.com>>

> To: PTManager <mailto:PTManager%40yahoogroups.com>

<PTManager <mailto:PTManager%40yahoogroups.com>>

> Sent: Wed Feb 25 16:20:17 2009

> Subject: Re: Re: Scheduling Medicare Patients

>

>

> Hi Mark,

>

> My local colleagues remind me that while the military PTs have a

huge degree

> of professional respect and autonomy, they do not tend to practice

as pure

> direct access as we know it but as part of an early

musculoskeletal primary

> care continuum (that might not be true for the therapists embedded

in active

> combat type situations). The system doesn't necessarily parallel

what most

> folks are familiar with, and some of that detail can be lost in

the " sound

> bytes " of posts.

>

> The PA or first responder generally triages all complaints

directing all

> musculoskeletal care through to PT and then PT determines if

ortho/phys

> medicine/podiatry needs to be involved, etc. When I worked with

hospital privileges

> at the local base, the level of communication was great, respect

was mutual

> and recognition of PT ability was on par with any other member of

the medical

> staff.

>

> Probably splitting a few hairs and this may not be universal, but

wanted you

> to know.

>

> Dee Daley, PT, DPT

> Southern Pines, NC

>

> Larry,

>

> I am finding the " Scheduling Medicare Patients " thread to be very

> interesting, but your post below caught my attention. I believe I

> understand what you are saying in relation to the military model

being the

> best because of the following features it has:

> 1. Direct access (if you are certified through the military's

program)

> 2. Professional autonomy

> 3. Ability to order some tests and medications

> 4. Professional recognition

>

> However, based on my knowledge of the military system (and I admit

it is not

> much), it is a government run healthcare system. The PT's are not

> practicing in private practice, they are working for the

government. It

> resembles a staff HMO from the perspective that the insurer (the

government)

> owns everything and employs everyone. The military can then

establish

> whatever rules they want and everyone has to abide by them.

>

> Based on your other posts, I assume this ownership aspect (or lack

thereof)

> is not what you are advocating for but rather it is the direct

access,

> autonomy, etc., correct? I just want to be sure I understand what

you are

> advocating for. Thanks!

>

> Mark Dwyer, PT, MHA

> Director of Rehabilitation Services

> Olathe Medical Center

> Olathe, Kansas

> _markdwyer87@markdwyer87_

(mailto:markdwyer87@...<mailto:markdwyer87%40comcast.net>)

>

> **************A Good Credit Score is 700 or Above. See yours in

just 2 easy

> steps!

> (http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?

redir=http:%2F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%

3D668072%26hmpgID

> %3D62%26bcd%3DfebemailfooterNO62)

>

>

[Guest guest]

:

Tough to compare. The military health care model (not just PT) is in part set

up that way due to the vast numbers and limited resources. The leverage they

get is caused from absolving themselves of the myriad of regulations that the

government places on everyone else. Relative to PT, it obviously works as they

are more productive on a per therapist basis and the PT's in the military as a

percent have more board certified specialists (they get professional pay for

doing it) and have produced more research. I can't speak to clinical outcomes

vs. non-military as I am not familiar with any research to that effect.

I would think the financial modeling using this practice would be significantly

more profitable. The hidden cost of compliance, documentation time, coding,

regulations, etc. are an incredible financial burden to a practice. Based on

what I have seen in the marketplace, there are many reasons why PT's leave

outpatient practice (private or other). They include the enormous pressure of

the environment when you take into account productivity pressure, absurd

documentation requirements, compliance, coding, differentiating payor sources,

clinical excellence, customer service, downward reimbursement and the like. Why

put up with that when you can make more money in another setting and perhaps

have more flexibility? Speaking strictly from an environment standpoint,

outpatient setting is becoming the most unattractive of all in the PT world.

This is not to suggest that other settings don't have some aspects of these

" pressures " but it is clear that more seasoned PT's are exiting outpatient for

other settings rather than the opposite.

_____________________________

Larry Benz PT, DPT

From: PTManager [mailto:PTManager ] On Behalf Of

s

Sent: Friday, February 27, 2009 8:55 AM

To: PTManager

Subject: Re: Scheduling Medicare Patients

Larry,

you raise some great points and questions to be considered. The one

thing that keeps jumping into my mind is the reimbursement issue.

In the private practice world we are constantly trying to squeeze a

modest profit margin out of the constraints of reimbursement vs.

overhead including the high cost of recruitment and retainment of

PTs who can certainly find more money in settings other than private

practice. I wonder, in the military world, if we broke down the

cost of doing businesss and compared it to what real world practice

owners face on an everyday basis,are we comparing apples to apples

or apples to oarnges? In other words, would the military world

practice model be viable in the real world, would it be profitable

if the space to practice had to be leased and the PT's were free to

negotiate salaries and to practice in whatever setting they chose,

and if a constant supply of patients had to be earned in competition

with other private practices through outcomes and marketing?

E. s, PT, DPT

Orthopedic Cliical Specialist

Fellow American Academy of Orthopedic Manual Physical Therapists

www.douglasspt.com

>

> Mark

>

> Thanks for the question. I am advocating for practice environment

and fighting for unfettered direct access and elimination of any

rules that fall outside of state practice acts with the obvious

exception of those standards of practice that have withstood the

vetting process of PT's (e.g. APTA practice standards). I also

completely buy into Vision 2020 which speaks to the ability for a

doctor of PT to determine the best interests of their patient versus

a set of dumbed down rules and procedures that reduce us to directed

technicians and result in the commodity perception where we end up

with a huge lobby now wanting ATC's equal access to medicare

patients! The whole notion that all PT has to be 1 on 1 or " skilled "

to be billed is ludicrous in my opinion. We don't hold MD's to that

same standard why should we PT " s? Going down a road to define

skilled vs. Non-skilled is a slippery slope. Again, we went to PT

school not Skilled PT school. An excellent point was made earlier

about the government absolving themselves from the rules they place

on everyone else-like military PT.

>

> I have made no exclusive claim on the ownership issue as I am not

of the belief that exclusive ownership and all PT " s are in private

practice is ever realistic or meaningful. I would rather strive for

realistic goals and outcomes given current health care debacle. We

all claim that the current number of underinsureds is too high-that

would provide even more reason to move to a military model for PT " s

which is in part meant to serve a greater number of patients with

less resources by allowing PT's to make judgements as they were

trained and not constrained by superimposed rules.

>

> Given a choice of seeing medicare (gov't) patients in a practice

environment where your time was spent with the patient and not

consumed with 8 min rule, plans of care/certification dates,

paranoia of supervision/1-1 rules, units, excessive documentation

requirements timed vs untimed codes,etc. Which would you choose?

> ____________________________________

> Larry

>

> Larry Benz

> 13000 Equity Place Suite 105

> Louisville, KY 40223

>

> This message, including any attachments, contains confidential

information intended for a specific individual and purpose.

>

> ________________________________

> From: PTManager <mailto:PTManager%40yahoogroups.com>

<PTManager <mailto:PTManager%40yahoogroups.com>>

> To: PTManager <mailto:PTManager%40yahoogroups.com>

<PTManager <mailto:PTManager%40yahoogroups.com>>

> Sent: Wed Feb 25 16:20:17 2009

> Subject: Re: Re: Scheduling Medicare Patients

>

>

> Hi Mark,

>

> My local colleagues remind me that while the military PTs have a

huge degree

> of professional respect and autonomy, they do not tend to practice

as pure

> direct access as we know it but as part of an early

musculoskeletal primary

> care continuum (that might not be true for the therapists embedded

in active

> combat type situations). The system doesn't necessarily parallel

what most

> folks are familiar with, and some of that detail can be lost in

the " sound

> bytes " of posts.

>

> The PA or first responder generally triages all complaints

directing all

> musculoskeletal care through to PT and then PT determines if

ortho/phys

> medicine/podiatry needs to be involved, etc. When I worked with

hospital privileges

> at the local base, the level of communication was great, respect

was mutual

> and recognition of PT ability was on par with any other member of

the medical

> staff.

>

> Probably splitting a few hairs and this may not be universal, but

wanted you

> to know.

>

> Dee Daley, PT, DPT

> Southern Pines, NC

>

> Larry,

>

> I am finding the " Scheduling Medicare Patients " thread to be very

> interesting, but your post below caught my attention. I believe I

> understand what you are saying in relation to the military model

being the

> best because of the following features it has:

> 1. Direct access (if you are certified through the military's

program)

> 2. Professional autonomy

> 3. Ability to order some tests and medications

> 4. Professional recognition

>

> However, based on my knowledge of the military system (and I admit

it is not

> much), it is a government run healthcare system. The PT's are not

> practicing in private practice, they are working for the

government. It

> resembles a staff HMO from the perspective that the insurer (the

government)

> owns everything and employs everyone. The military can then

establish

> whatever rules they want and everyone has to abide by them.

>

> Based on your other posts, I assume this ownership aspect (or lack

thereof)

> is not what you are advocating for but rather it is the direct

access,

> autonomy, etc., correct? I just want to be sure I understand what

you are

> advocating for. Thanks!

>

> Mark Dwyer, PT, MHA

> Director of Rehabilitation Services

> Olathe Medical Center

> Olathe, Kansas

> _markdwyer87@markdwyer87_

(mailto:markdwyer87@...<mailto:markdwyer87%40comcast.net>)

>

> **************A Good Credit Score is 700 or Above. See yours in

just 2 easy

> steps!

> (http://pr.atwola.com/promoclk/100126575x1218822736x1201267884/aol?

redir=http:%2F%2Fwww.freecreditreport.com%2Fpm%2Fdefault.aspx%3Fsc%

3D668072%26hmpgID

> %3D62%26bcd%3DfebemailfooterNO62)

>

>

[Guest guest]

Larry,

I would agree, tough to compare. I really admire all of the work,

con ed and research the military PT's have been able to contribute to

the profession over the last several years and often wonder how much

more I could contribute if I wasnt constantly seeing patients in

order to pay the bills, but, and a huge but, I have my automomy and I

keep my profits and can return a portion of them to the profession.

Who keeps the profits in the military world? are there profits? do

they work at a loss? Are they doing all the research and continuing

their education on the taxpayer dollar? If the model is really

viable does that mean natonalized health care following this model

would be viable or would the costs be too great? Would make an

interesting study, the comparison of the two systems.

As for the outpatient setting becoming the most unattractive in the

PT world with more seasoned PT's leaving it for other settings, I

wonder where you came up with this information. On last check, the

Private Practice Section was the fastest growing section of the APTA

and more PT's are practice owners now than ever before. I see the

shift as being one from the corporate outpatient world to the PT

owned world, not out of outpatient altogether.

Enjoying the converstation,

E. s, PT, DPT

> Orthopedic Cliical Specialist

> Fellow American Academy of Orthopedic Manual Physical Therapists

> www.douglasspt.com

> >

> > Mark

> >

> > Thanks for the question. I am advocating for practice environment

> and fighting for unfettered direct access and elimination of any

> rules that fall outside of state practice acts with the obvious

> exception of those standards of practice that have withstood the

> vetting process of PT's (e.g. APTA practice standards). I also

> completely buy into Vision 2020 which speaks to the ability for a

> doctor of PT to determine the best interests of their patient versus

> a set of dumbed down rules and procedures that reduce us to directed

> technicians and result in the commodity perception where we end up

> with a huge lobby now wanting ATC's equal access to medicare

> patients! The whole notion that all PT has to be 1 on 1 or " skilled "

> to be billed is ludicrous in my opinion. We don't hold MD's to that

> same standard why should we PT " s? Going down a road to define

> skilled vs. Non-skilled is a slippery slope. Again, we went to PT

> school not Skilled PT school. An excellent point was made earlier

> about the government absolving themselves from the rules they place

> on everyone else-like military PT.

> >

> > I have made no exclusive claim on the ownership issue as I am not

> of the belief that exclusive ownership and all PT " s are in private

> practice is ever realistic or meaningful. I would rather strive for

> realistic goals and outcomes given current health care debacle. We

> all claim that the current number of underinsureds is too high-that

> would provide even more reason to move to a military model for PT " s

> which is in part meant to serve a greater number of patients with

> less resources by allowing PT's to make judgements as they were

> trained and not constrained by superimposed rules.

> >

> > Given a choice of seeing medicare (gov't) patients in a practice

> environment where your time was spent with the patient and not

> consumed with 8 min rule, plans of care/certification dates,

> paranoia of supervision/1-1 rules, units, excessive documentation

> requirements timed vs untimed codes,etc. Which would you choose?

> > ____________________________________

> > Larry

> >

> > Larry Benz

> > 13000 Equity Place Suite 105

> > Louisville, KY 40223

> >

> > This message, including any attachments, contains confidential

> information intended for a specific individual and purpose.

> >

> > ________________________________

> > From: PTManager <mailto:PTManager%

40yahoogroups.com> <PTManager <mailto:PTManager%

40yahoogroups.com>>

> > To: PTManager <mailto:PTManager%40yahoogroups.com>

<PTManager <mailto:PTManager%40yahoogroups.com>>

> > Sent: Wed Feb 25 16:20:17 2009

> > Subject: Re: Re: Scheduling Medicare Patients

> >

> >

> > Hi Mark,

> >

> > My local colleagues remind me that while the military PTs have a

> huge degree

> > of professional respect and autonomy, they do not tend to practice

> as pure

> > direct access as we know it but as part of an early

> musculoskeletal primary

> > care continuum (that might not be true for the therapists embedded

> in active

> > combat type situations). The system doesn't necessarily parallel

> what most

> > folks are familiar with, and some of that detail can be lost in

> the " sound

> > bytes " of posts.

> >

> > The PA or first responder generally triages all complaints

> directing all

> > musculoskeletal care through to PT and then PT determines if

> ortho/phys

> > medicine/podiatry needs to be involved, etc. When I worked with

> hospital privileges

> > at the local base, the level of communication was great, respect

> was mutual

> > and recognition of PT ability was on par with any other member of

> the medical

> > staff.

> >

> > Probably splitting a few hairs and this may not be universal, but

> wanted you

> > to know.

> >

> > Dee Daley, PT, DPT

> > Southern Pines, NC

> >

> > Larry,

> >

> > I am finding the " Scheduling Medicare Patients " thread to be very

> > interesting, but your post below caught my attention. I believe I

> > understand what you are saying in relation to the military model

> being the

> > best because of the following features it has:

> > 1. Direct access (if you are certified through the military's

> program)

> > 2. Professional autonomy

> > 3. Ability to order some tests and medications

> > 4. Professional recognition

> >

> > However, based on my knowledge of the military system (and I admit

> it is not

> > much), it is a government run healthcare system. The PT's are not

> > practicing in private practice, they are working for the

> government. It

> > resembles a staff HMO from the perspective that the insurer (the

> government)

> > owns everything and employs everyone. The military can then

> establish

> > whatever rules they want and everyone has to abide by them.

> >

> > Based on your other posts, I assume this ownership aspect (or lack

> thereof)

> > is not what you are advocating for but rather it is the direct

> access,

> > autonomy, etc., correct? I just want to be sure I understand what

> you are

> > advocating for. Thanks!

> >

> > Mark Dwyer, PT, MHA

> > Director of Rehabilitation Services

> > Olathe Medical Center

> > Olathe, Kansas

> > _markdwyer87@markdwyer87_

> (mailto:markdwyer87@<mailto:markdwyer87%40comcast.net>)

> >

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