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Re: Scheduling Medicare Patients

By Guest guest, in Health, Medicine and Natural Healing 09

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Guest guest   

Guest guest
Posted

To all,

How does the military reimburse for PT services? My guess is that it

is not a third party payer system. Does the military both employ the PT

and reimburse for their services? Are the military PT's working on

a fixed salary or are they paid on a productivity basis (per visit) as

are private practice owners? If they are on a fixed salary then

wouldn't it be obvious for the `system' to want the PT's

to see as many patients as possible?

Would it be accurate to say that the military system is comparable to a

fictitious model of a PT employed by Medicare to treat only Medicare

patients? If this is an accurate comparison then it would be

advantageous for the employer/payer to dispel with much of the

regulatory guidelines and encourage the PT's to see as many patients as

possible since they are on a fixed salary? What an attractive business

model for the payer! (higher productivity per salary dollars spent)

If this is a somewhat accurate view of the reimbursement end of the

military system, then it cannot be accurately compared to private

practice. To me, the only attractive part of the military system would

be the decreased regulation and increased autonomy. What private

practice owner would want to increase their caseloads without a

concomitate increase in their income?

Am I looking at this all wrong? Forgive me if I'm totally off base

(pun intended). I'm trying to figure out how the military

reimbursement systmem compares to private industry and third party

payers.

Thanks,

Jon Mark Pleasant, PT

> >

> > 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)

> >

> >

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Guest guest   

Guest guest
Posted

To all,

How does the military reimburse for PT services? My guess is that it

is not a third party payer system. Does the military both employ the PT

and reimburse for their services? Are the military PT's working on

a fixed salary or are they paid on a productivity basis (per visit) as

are private practice owners? If they are on a fixed salary then

wouldn't it be obvious for the `system' to want the PT's

to see as many patients as possible?

Would it be accurate to say that the military system is comparable to a

fictitious model of a PT employed by Medicare to treat only Medicare

patients? If this is an accurate comparison then it would be

advantageous for the employer/payer to dispel with much of the

regulatory guidelines and encourage the PT's to see as many patients as

possible since they are on a fixed salary? What an attractive business

model for the payer! (higher productivity per salary dollars spent)

If this is a somewhat accurate view of the reimbursement end of the

military system, then it cannot be accurately compared to private

practice. To me, the only attractive part of the military system would

be the decreased regulation and increased autonomy. What private

practice owner would want to increase their caseloads without a

concomitate increase in their income?

Am I looking at this all wrong? Forgive me if I'm totally off base

(pun intended). I'm trying to figure out how the military

reimbursement systmem compares to private industry and third party

payers.

Thanks,

Jon Mark Pleasant, PT

> >

> > 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)

> >

> >

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Guest guest   

Guest guest
Posted

To all,

How does the military reimburse for PT services? My guess is that it

is not a third party payer system. Does the military both employ the PT

and reimburse for their services? Are the military PT's working on

a fixed salary or are they paid on a productivity basis (per visit) as

are private practice owners? If they are on a fixed salary then

wouldn't it be obvious for the `system' to want the PT's

to see as many patients as possible?

Would it be accurate to say that the military system is comparable to a

fictitious model of a PT employed by Medicare to treat only Medicare

patients? If this is an accurate comparison then it would be

advantageous for the employer/payer to dispel with much of the

regulatory guidelines and encourage the PT's to see as many patients as

possible since they are on a fixed salary? What an attractive business

model for the payer! (higher productivity per salary dollars spent)

If this is a somewhat accurate view of the reimbursement end of the

military system, then it cannot be accurately compared to private

practice. To me, the only attractive part of the military system would

be the decreased regulation and increased autonomy. What private

practice owner would want to increase their caseloads without a

concomitate increase in their income?

Am I looking at this all wrong? Forgive me if I'm totally off base

(pun intended). I'm trying to figure out how the military

reimbursement systmem compares to private industry and third party

payers.

Thanks,

Jon Mark Pleasant, PT

> >

> > 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)

> >

> >

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Guest guest   

Guest guest
Posted

It would be interesting to see if APTA or others have the data to support the

statement made by Larry that " but it is clear that more seasoned PT's are

exiting outpatient for other settings rather than the opposite " . I personally do

not see PT's with 10 years or greater of experience moving to the SNF setting or

hospital inpatient setting where the physical aspect of the job may be much more

demanding in terms of the physical limitations of the patients (i.e. bed

mobility, transfers, etc.)

 

I agree with Larry regarding all the demands on therapists now in all outpatient

settings. In addition to those in outpatient settings, add in the " The Joint

Commission " surveys, CARF surveys, Press Ganey patient satisfaction surveys,

etc. that mainly occur in hospitals, home health agencies, and SNF's, and not in

the private practice setting. Also add in the various State and CMS surveys that

happen frequently in the before mentioned settings, either due to yearly surveys

or due to a patient/family complaint that usually has no merit. Those do not

happen that often in the private practice setting.

 

Finally, Beaumont Hospital in the suburbs of Michigan, with good insurance

payers, lost $29.5 million in 2008 and is cutting another 84 jobs in addition to

the 500 they cut last year. Beaumont is doing all of this to try and make $31

million in 2009 that would give them a 1.4% operating margin. For those of you

that think all hospitals have it good, they do not.

 

http://www.freep.com/article/20090228/BUSINESS06/902280310/1019/BUSINESS/Beaumon\

t+loses+$29.5+million++to+cut+84+more+jobs

 

Rick Gawenda, PT

Gawenda Seminars

www.gawendaseminars.com

Subject: RE: Re: Scheduling Medicare Patients

To: " PTManager " <PTManager >

Date: Sunday, March 1, 2009, 7:45 AM

:

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@yahoogrou ps.com [mailto:PTManager@yahoogrou ps.com] On Behalf

Of s

Sent: Friday, February 27, 2009 8:55 AM

To: PTManager@yahoogrou ps.com

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

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

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

<PTManager@yahoogrou ps.com<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/ 100126575x121882 2736x1201267884/ aol?

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

3D668072%26hmpgID

> %3D62%26bcd% 3Dfebemailfooter NO62)

>

>

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Guest guest   

Guest guest
Posted

It would be interesting to see if APTA or others have the data to support the

statement made by Larry that " but it is clear that more seasoned PT's are

exiting outpatient for other settings rather than the opposite " . I personally do

not see PT's with 10 years or greater of experience moving to the SNF setting or

hospital inpatient setting where the physical aspect of the job may be much more

demanding in terms of the physical limitations of the patients (i.e. bed

mobility, transfers, etc.)

 

I agree with Larry regarding all the demands on therapists now in all outpatient

settings. In addition to those in outpatient settings, add in the " The Joint

Commission " surveys, CARF surveys, Press Ganey patient satisfaction surveys,

etc. that mainly occur in hospitals, home health agencies, and SNF's, and not in

the private practice setting. Also add in the various State and CMS surveys that

happen frequently in the before mentioned settings, either due to yearly surveys

or due to a patient/family complaint that usually has no merit. Those do not

happen that often in the private practice setting.

 

Finally, Beaumont Hospital in the suburbs of Michigan, with good insurance

payers, lost $29.5 million in 2008 and is cutting another 84 jobs in addition to

the 500 they cut last year. Beaumont is doing all of this to try and make $31

million in 2009 that would give them a 1.4% operating margin. For those of you

that think all hospitals have it good, they do not.

 

http://www.freep.com/article/20090228/BUSINESS06/902280310/1019/BUSINESS/Beaumon\

t+loses+$29.5+million++to+cut+84+more+jobs

 

Rick Gawenda, PT

Gawenda Seminars

www.gawendaseminars.com

Subject: RE: Re: Scheduling Medicare Patients

To: " PTManager " <PTManager >

Date: Sunday, March 1, 2009, 7:45 AM

:

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@yahoogrou ps.com [mailto:PTManager@yahoogrou ps.com] On Behalf

Of s

Sent: Friday, February 27, 2009 8:55 AM

To: PTManager@yahoogrou ps.com

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

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

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

<PTManager@yahoogrou ps.com<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/ 100126575x121882 2736x1201267884/ aol?

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

3D668072%26hmpgID

> %3D62%26bcd% 3Dfebemailfooter NO62)

>

>

Share this post

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Share on other sites

Guest guest   

Guest guest
Posted

It would be interesting to see if APTA or others have the data to support the

statement made by Larry that " but it is clear that more seasoned PT's are

exiting outpatient for other settings rather than the opposite " . I personally do

not see PT's with 10 years or greater of experience moving to the SNF setting or

hospital inpatient setting where the physical aspect of the job may be much more

demanding in terms of the physical limitations of the patients (i.e. bed

mobility, transfers, etc.)

 

I agree with Larry regarding all the demands on therapists now in all outpatient

settings. In addition to those in outpatient settings, add in the " The Joint

Commission " surveys, CARF surveys, Press Ganey patient satisfaction surveys,

etc. that mainly occur in hospitals, home health agencies, and SNF's, and not in

the private practice setting. Also add in the various State and CMS surveys that

happen frequently in the before mentioned settings, either due to yearly surveys

or due to a patient/family complaint that usually has no merit. Those do not

happen that often in the private practice setting.

 

Finally, Beaumont Hospital in the suburbs of Michigan, with good insurance

payers, lost $29.5 million in 2008 and is cutting another 84 jobs in addition to

the 500 they cut last year. Beaumont is doing all of this to try and make $31

million in 2009 that would give them a 1.4% operating margin. For those of you

that think all hospitals have it good, they do not.

 

http://www.freep.com/article/20090228/BUSINESS06/902280310/1019/BUSINESS/Beaumon\

t+loses+$29.5+million++to+cut+84+more+jobs

 

Rick Gawenda, PT

Gawenda Seminars

www.gawendaseminars.com

Subject: RE: Re: Scheduling Medicare Patients

To: " PTManager " <PTManager >

Date: Sunday, March 1, 2009, 7:45 AM

:

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@yahoogrou ps.com [mailto:PTManager@yahoogrou ps.com] On Behalf

Of s

Sent: Friday, February 27, 2009 8:55 AM

To: PTManager@yahoogrou ps.com

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

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

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

<PTManager@yahoogrou ps.com<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/ 100126575x121882 2736x1201267884/ aol?

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

3D668072%26hmpgID

> %3D62%26bcd% 3Dfebemailfooter NO62)

>

>

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Guest guest   

Guest guest
Posted

Rick,

Locally, I have noticed that experienced therapists are opting to go into other

settings that can provide them time off, stability and increased salaries

(particularly home care). I'm in NY, one of the worst reimbursing regions for

third party payors, and have spoken to therapists about this. Although I have

not researched/surveyed it, this is some of the data that I've come to know.

Personally, being in OP for 8 years I couldn't do otherwise. Again, from a

PT-PAC viewpoint, I can't help bit wonder how our lobbying powers would change

positions if more PT's (only 13 percent of PT's do- national) contributed to the

PAC.

Vinod

Sent from my BlackBerry® smartphone with SprintSpeed

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/ 100126575x121882 2736x1201267884/ aol?

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

3D668072%26hmpgID

> %3D62%26bcd% 3Dfebemailfooter NO62)

>

>

Share this post

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Share on other sites

Guest guest   

Guest guest
Posted

Rick,

Locally, I have noticed that experienced therapists are opting to go into other

settings that can provide them time off, stability and increased salaries

(particularly home care). I'm in NY, one of the worst reimbursing regions for

third party payors, and have spoken to therapists about this. Although I have

not researched/surveyed it, this is some of the data that I've come to know.

Personally, being in OP for 8 years I couldn't do otherwise. Again, from a

PT-PAC viewpoint, I can't help bit wonder how our lobbying powers would change

positions if more PT's (only 13 percent of PT's do- national) contributed to the

PAC.

Vinod

Sent from my BlackBerry® smartphone with SprintSpeed

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/ 100126575x121882 2736x1201267884/ aol?

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

3D668072%26hmpgID

> %3D62%26bcd% 3Dfebemailfooter NO62)

>

>

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Guest guest   

Guest guest
Posted

Rick,

Locally, I have noticed that experienced therapists are opting to go into other

settings that can provide them time off, stability and increased salaries

(particularly home care). I'm in NY, one of the worst reimbursing regions for

third party payors, and have spoken to therapists about this. Although I have

not researched/surveyed it, this is some of the data that I've come to know.

Personally, being in OP for 8 years I couldn't do otherwise. Again, from a

PT-PAC viewpoint, I can't help bit wonder how our lobbying powers would change

positions if more PT's (only 13 percent of PT's do- national) contributed to the

PAC.

Vinod

Sent from my BlackBerry® smartphone with SprintSpeed

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/ 100126575x121882 2736x1201267884/ aol?

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

3D668072%26hmpgID

> %3D62%26bcd% 3Dfebemailfooter NO62)

>

>

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Guest guest   

Guest guest
Posted

Rick:

For clarification purposes, I should have put a qualifier on " seasoned " . You

use 10 years and in my experience, I would use from 2-10 as a group that I am

seeing exit outpatient-most typically for home care and not nearly as much for

SNF and seldom based just on my experience for hospital inpatient which I

understand has the highest national shortage. I am not sure if APTA has data on

this.

__________________________________________

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.

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/ 100126575x121882 2736x1201267884/ aol?

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

3D668072%26hmpgID

> %3D62%26bcd% 3Dfebemailfooter NO62)

>

>

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Guest guest   

Guest guest
Posted

Rick:

For clarification purposes, I should have put a qualifier on " seasoned " . You

use 10 years and in my experience, I would use from 2-10 as a group that I am

seeing exit outpatient-most typically for home care and not nearly as much for

SNF and seldom based just on my experience for hospital inpatient which I

understand has the highest national shortage. I am not sure if APTA has data on

this.

__________________________________________

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.

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/ 100126575x121882 2736x1201267884/ aol?

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

3D668072%26hmpgID

> %3D62%26bcd% 3Dfebemailfooter NO62)

>

>

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Guest guest   

Guest guest
Posted

Rick:

For clarification purposes, I should have put a qualifier on " seasoned " . You

use 10 years and in my experience, I would use from 2-10 as a group that I am

seeing exit outpatient-most typically for home care and not nearly as much for

SNF and seldom based just on my experience for hospital inpatient which I

understand has the highest national shortage. I am not sure if APTA has data on

this.

__________________________________________

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.

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/ 100126575x121882 2736x1201267884/ aol?

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

3D668072%26hmpgID

> %3D62%26bcd% 3Dfebemailfooter NO62)

>

>

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Guest guest   

Guest guest
Posted

I think what is happening, or at least what I am seeing personally, is

that the most skilled and experienced of outpatient PT's don't want to

work for a treatment mill nor a POPTS unless they have no other

optipns. As a result, the best outpatient PT's of our profession are

either opening a new clinic, or moving back into hospital outpatient

centers.

M. Ball, PT, DPT, Ph.D

Charlotte, NC

> Rick,

>

> Locally, I have noticed that experienced therapists are opting to go

> into other settings that can provide them time off, stability and

> increased salaries (particularly home care). I'm in NY, one of the

> worst reimbursing regions for third party payors, and have spoken to

> therapists about this. Although I have not researched/surveyed it,

> this is some of the data that I've come to know. Personally, being

> in OP for 8 years I couldn't do otherwise. Again, from a PT-PAC

> viewpoint, I can't help bit wonder how our lobbying powers would

> change positions if more PT's (only 13 percent of PT's do- national)

> contributed to the PAC.

> Vinod

> Sent from my BlackBerry® smartphone with SprintSpeed

>

> RE: Re: Scheduling Medicare Patients

>

>

> It would be interesting to see if APTA or others have the data to

> support the statement made by Larry that " but it is clear that more

> seasoned PT's are exiting outpatient for other settings rather than

> the opposite " . I personally do not see PT's with 10 years or greater

> of experience moving to the SNF setting or hospital inpatient

> setting where the physical aspect of the job may be much more

> demanding in terms of the physical limitations of the patients (i.e.

> bed mobility, transfers, etc.)

>

> I agree with Larry regarding all the demands on therapists now in

> all outpatient settings. In addition to those in outpatient

> settings, add in the " The Joint Commission " surveys, CARF surveys,

> Press Ganey patient satisfaction surveys, etc. that mainly occur in

> hospitals, home health agencies, and SNF's, and not in the private

> practice setting. Also add in the various State and CMS surveys that

> happen frequently in the before mentioned settings, either due to

> yearly surveys or due to a patient/family complaint that usually has

> no merit. Those do not happen that often in the private practice

> setting.

>

>

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Guest guest   

Guest guest
Posted

I think what is happening, or at least what I am seeing personally, is

that the most skilled and experienced of outpatient PT's don't want to

work for a treatment mill nor a POPTS unless they have no other

optipns. As a result, the best outpatient PT's of our profession are

either opening a new clinic, or moving back into hospital outpatient

centers.

M. Ball, PT, DPT, Ph.D

Charlotte, NC

> Rick,

>

> Locally, I have noticed that experienced therapists are opting to go

> into other settings that can provide them time off, stability and

> increased salaries (particularly home care). I'm in NY, one of the

> worst reimbursing regions for third party payors, and have spoken to

> therapists about this. Although I have not researched/surveyed it,

> this is some of the data that I've come to know. Personally, being

> in OP for 8 years I couldn't do otherwise. Again, from a PT-PAC

> viewpoint, I can't help bit wonder how our lobbying powers would

> change positions if more PT's (only 13 percent of PT's do- national)

> contributed to the PAC.

> Vinod

> Sent from my BlackBerry® smartphone with SprintSpeed

>

> RE: Re: Scheduling Medicare Patients

>

>

> It would be interesting to see if APTA or others have the data to

> support the statement made by Larry that " but it is clear that more

> seasoned PT's are exiting outpatient for other settings rather than

> the opposite " . I personally do not see PT's with 10 years or greater

> of experience moving to the SNF setting or hospital inpatient

> setting where the physical aspect of the job may be much more

> demanding in terms of the physical limitations of the patients (i.e.

> bed mobility, transfers, etc.)

>

> I agree with Larry regarding all the demands on therapists now in

> all outpatient settings. In addition to those in outpatient

> settings, add in the " The Joint Commission " surveys, CARF surveys,

> Press Ganey patient satisfaction surveys, etc. that mainly occur in

> hospitals, home health agencies, and SNF's, and not in the private

> practice setting. Also add in the various State and CMS surveys that

> happen frequently in the before mentioned settings, either due to

> yearly surveys or due to a patient/family complaint that usually has

> no merit. Those do not happen that often in the private practice

> setting.

>

>

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Guest guest   

Guest guest
Posted

I think what is happening, or at least what I am seeing personally, is

that the most skilled and experienced of outpatient PT's don't want to

work for a treatment mill nor a POPTS unless they have no other

optipns. As a result, the best outpatient PT's of our profession are

either opening a new clinic, or moving back into hospital outpatient

centers.

M. Ball, PT, DPT, Ph.D

Charlotte, NC

> Rick,

>

> Locally, I have noticed that experienced therapists are opting to go

> into other settings that can provide them time off, stability and

> increased salaries (particularly home care). I'm in NY, one of the

> worst reimbursing regions for third party payors, and have spoken to

> therapists about this. Although I have not researched/surveyed it,

> this is some of the data that I've come to know. Personally, being

> in OP for 8 years I couldn't do otherwise. Again, from a PT-PAC

> viewpoint, I can't help bit wonder how our lobbying powers would

> change positions if more PT's (only 13 percent of PT's do- national)

> contributed to the PAC.

> Vinod

> Sent from my BlackBerry® smartphone with SprintSpeed

>

> RE: Re: Scheduling Medicare Patients

>

>

> It would be interesting to see if APTA or others have the data to

> support the statement made by Larry that " but it is clear that more

> seasoned PT's are exiting outpatient for other settings rather than

> the opposite " . I personally do not see PT's with 10 years or greater

> of experience moving to the SNF setting or hospital inpatient

> setting where the physical aspect of the job may be much more

> demanding in terms of the physical limitations of the patients (i.e.

> bed mobility, transfers, etc.)

>

> I agree with Larry regarding all the demands on therapists now in

> all outpatient settings. In addition to those in outpatient

> settings, add in the " The Joint Commission " surveys, CARF surveys,

> Press Ganey patient satisfaction surveys, etc. that mainly occur in

> hospitals, home health agencies, and SNF's, and not in the private

> practice setting. Also add in the various State and CMS surveys that

> happen frequently in the before mentioned settings, either due to

> yearly surveys or due to a patient/family complaint that usually has

> no merit. Those do not happen that often in the private practice

> setting.

>

>

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Guest guest   

Guest guest
Posted

Jon Mark, et. al. -

Although it's been... 40 years this spring... since I finished Combat Medic

Training and went to the Army's PT Specialist (91J20) course before proudly

spending a couple of years at General Hospital with some of the

finest real therapists I've met, I think that the Army still works in a

similar manner. They train or recruit their own professionals as officers

and enlisted, and then " take care of their own " . Soldiers and sailors are

not charged for their medical services, nor do their comrades expect such

payment. In fact, tens of thousands of service members donate blood

regularly for use by their comrades in arms. I think that new therapists

may receive about $3,000/month plus substantial benefits.

In emergencies, when the military personnel may be deployed overseas, they

may contract out the operation of a stateside facility to a large civilian

contractor, such as Humana. Sometimes, they may hire civilian therapists.

Military PTs, PTAs, physicians and nurses as well as dozens of other medical

personnel, get paid as military personnel. Just like an Air Force pilot, a

Navy SEAL, or an Army Combat Medic, if they are tasked to go somewhere and

do something... They do it.

The armed services are mission-driven, rather than profit-driven

organizations. ( " Conserve the Fighting Strength!) They are also large

enough to operate their own hospitals and clinics, using their own service

members ( " employees " , albeit low-paid, if you will). Those medical

activities operate on annual budgets of the Departments of the Army, Navy,

and Air Force. Marines and Coast Guardsmen use Naval facilities and

professionals, in general. The Navy even operates two fully equipped 1200

bed hospital ships based on the hulls of supertankers!

They operate some of their own educational programs, such as the Army-Baylor

program at Army Medical Center's Academy of the Health Sciences and a

medical university for the armed services, producing physicians. They also

have hundreds -- perhaps thousands -- of scholarship students on Army or

Navy Reserve scholarships, involving a commitment after graduation.

And... they DO need PTs right now!

http://www.goarmy.com/JobDetail.do?id=314

or, for the Naval inclined:

http://www.navy.com/careers/healthcare/medicalservicecorps/clinicalcareprovi

ders/physicaltherapy/

and Air Force:

http://www.airforce.com/opportunities/healthcare/careers/biomedical-sciences

/physical-therapist/?view=list

Grateful for their service,

Dick Hillyer, PT

Sp5/E5 W. Hillyer

BGH/MFSS/BAMC

Ft. Sam Houston, TX

(1968-1971)

_____

From: PTManager [mailto:PTManager ] On Behalf

Of jonmarkpleasant

Sent: Sunday, March 01, 2009 2:03 PM

To: PTManager

Subject: Re: Scheduling Medicare Patients

To all,

How does the military reimburse for PT services? My guess is that it

is not a third party payer system. Does the military both employ the PT

and reimburse for their services? Are the military PT's working on

a fixed salary or are they paid on a productivity basis (per visit) as

are private practice owners? If they are on a fixed salary then

wouldn't it be obvious for the `system' to want the PT's

to see as many patients as possible?

Would it be accurate to say that the military system is comparable to a

fictitious model of a PT employed by Medicare to treat only Medicare

patients? If this is an accurate comparison then it would be

advantageous for the employer/payer to dispel with much of the

regulatory guidelines and encourage the PT's to see as many patients as

possible since they are on a fixed salary? What an attractive business

model for the payer! (higher productivity per salary dollars spent)

If this is a somewhat accurate view of the reimbursement end of the

military system, then it cannot be accurately compared to private

practice. To me, the only attractive part of the military system would

be the decreased regulation and increased autonomy. What private

practice owner would want to increase their caseloads without a

concomitate increase in their income?

Am I looking at this all wrong? Forgive me if I'm totally off base

(pun intended). I'm trying to figure out how the military

reimbursement systmem compares to private industry and third party

payers.

Thanks,

Jon Mark Pleasant, PT

> >

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

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

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

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

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

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

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

ps.com<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.

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

com/promoclk/100126575x1218822736x1201267884/aol?

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

> 3D668072%26hmpgID

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

> >

> >

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Guest guest   

Guest guest
Posted

Jon Mark, et. al. -

Although it's been... 40 years this spring... since I finished Combat Medic

Training and went to the Army's PT Specialist (91J20) course before proudly

spending a couple of years at General Hospital with some of the

finest real therapists I've met, I think that the Army still works in a

similar manner. They train or recruit their own professionals as officers

and enlisted, and then " take care of their own " . Soldiers and sailors are

not charged for their medical services, nor do their comrades expect such

payment. In fact, tens of thousands of service members donate blood

regularly for use by their comrades in arms. I think that new therapists

may receive about $3,000/month plus substantial benefits.

In emergencies, when the military personnel may be deployed overseas, they

may contract out the operation of a stateside facility to a large civilian

contractor, such as Humana. Sometimes, they may hire civilian therapists.

Military PTs, PTAs, physicians and nurses as well as dozens of other medical

personnel, get paid as military personnel. Just like an Air Force pilot, a

Navy SEAL, or an Army Combat Medic, if they are tasked to go somewhere and

do something... They do it.

The armed services are mission-driven, rather than profit-driven

organizations. ( " Conserve the Fighting Strength!) They are also large

enough to operate their own hospitals and clinics, using their own service

members ( " employees " , albeit low-paid, if you will). Those medical

activities operate on annual budgets of the Departments of the Army, Navy,

and Air Force. Marines and Coast Guardsmen use Naval facilities and

professionals, in general. The Navy even operates two fully equipped 1200

bed hospital ships based on the hulls of supertankers!

They operate some of their own educational programs, such as the Army-Baylor

program at Army Medical Center's Academy of the Health Sciences and a

medical university for the armed services, producing physicians. They also

have hundreds -- perhaps thousands -- of scholarship students on Army or

Navy Reserve scholarships, involving a commitment after graduation.

And... they DO need PTs right now!

http://www.goarmy.com/JobDetail.do?id=314

or, for the Naval inclined:

http://www.navy.com/careers/healthcare/medicalservicecorps/clinicalcareprovi

ders/physicaltherapy/

and Air Force:

http://www.airforce.com/opportunities/healthcare/careers/biomedical-sciences

/physical-therapist/?view=list

Grateful for their service,

Dick Hillyer, PT

Sp5/E5 W. Hillyer

BGH/MFSS/BAMC

Ft. Sam Houston, TX

(1968-1971)

_____

From: PTManager [mailto:PTManager ] On Behalf

Of jonmarkpleasant

Sent: Sunday, March 01, 2009 2:03 PM

To: PTManager

Subject: Re: Scheduling Medicare Patients

To all,

How does the military reimburse for PT services? My guess is that it

is not a third party payer system. Does the military both employ the PT

and reimburse for their services? Are the military PT's working on

a fixed salary or are they paid on a productivity basis (per visit) as

are private practice owners? If they are on a fixed salary then

wouldn't it be obvious for the `system' to want the PT's

to see as many patients as possible?

Would it be accurate to say that the military system is comparable to a

fictitious model of a PT employed by Medicare to treat only Medicare

patients? If this is an accurate comparison then it would be

advantageous for the employer/payer to dispel with much of the

regulatory guidelines and encourage the PT's to see as many patients as

possible since they are on a fixed salary? What an attractive business

model for the payer! (higher productivity per salary dollars spent)

If this is a somewhat accurate view of the reimbursement end of the

military system, then it cannot be accurately compared to private

practice. To me, the only attractive part of the military system would

be the decreased regulation and increased autonomy. What private

practice owner would want to increase their caseloads without a

concomitate increase in their income?

Am I looking at this all wrong? Forgive me if I'm totally off base

(pun intended). I'm trying to figure out how the military

reimbursement systmem compares to private industry and third party

payers.

Thanks,

Jon Mark Pleasant, PT

> >

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

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

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

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

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

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

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

ps.com<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.

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

com/promoclk/100126575x1218822736x1201267884/aol?

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

> 3D668072%26hmpgID

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

> >

> >

Share this post

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Guest guest   

Guest guest
Posted

Jon Mark, et. al. -

Although it's been... 40 years this spring... since I finished Combat Medic

Training and went to the Army's PT Specialist (91J20) course before proudly

spending a couple of years at General Hospital with some of the

finest real therapists I've met, I think that the Army still works in a

similar manner. They train or recruit their own professionals as officers

and enlisted, and then " take care of their own " . Soldiers and sailors are

not charged for their medical services, nor do their comrades expect such

payment. In fact, tens of thousands of service members donate blood

regularly for use by their comrades in arms. I think that new therapists

may receive about $3,000/month plus substantial benefits.

In emergencies, when the military personnel may be deployed overseas, they

may contract out the operation of a stateside facility to a large civilian

contractor, such as Humana. Sometimes, they may hire civilian therapists.

Military PTs, PTAs, physicians and nurses as well as dozens of other medical

personnel, get paid as military personnel. Just like an Air Force pilot, a

Navy SEAL, or an Army Combat Medic, if they are tasked to go somewhere and

do something... They do it.

The armed services are mission-driven, rather than profit-driven

organizations. ( " Conserve the Fighting Strength!) They are also large

enough to operate their own hospitals and clinics, using their own service

members ( " employees " , albeit low-paid, if you will). Those medical

activities operate on annual budgets of the Departments of the Army, Navy,

and Air Force. Marines and Coast Guardsmen use Naval facilities and

professionals, in general. The Navy even operates two fully equipped 1200

bed hospital ships based on the hulls of supertankers!

They operate some of their own educational programs, such as the Army-Baylor

program at Army Medical Center's Academy of the Health Sciences and a

medical university for the armed services, producing physicians. They also

have hundreds -- perhaps thousands -- of scholarship students on Army or

Navy Reserve scholarships, involving a commitment after graduation.

And... they DO need PTs right now!

http://www.goarmy.com/JobDetail.do?id=314

or, for the Naval inclined:

http://www.navy.com/careers/healthcare/medicalservicecorps/clinicalcareprovi

ders/physicaltherapy/

and Air Force:

http://www.airforce.com/opportunities/healthcare/careers/biomedical-sciences

/physical-therapist/?view=list

Grateful for their service,

Dick Hillyer, PT

Sp5/E5 W. Hillyer

BGH/MFSS/BAMC

Ft. Sam Houston, TX

(1968-1971)

_____

From: PTManager [mailto:PTManager ] On Behalf

Of jonmarkpleasant

Sent: Sunday, March 01, 2009 2:03 PM

To: PTManager

Subject: Re: Scheduling Medicare Patients

To all,

How does the military reimburse for PT services? My guess is that it

is not a third party payer system. Does the military both employ the PT

and reimburse for their services? Are the military PT's working on

a fixed salary or are they paid on a productivity basis (per visit) as

are private practice owners? If they are on a fixed salary then

wouldn't it be obvious for the `system' to want the PT's

to see as many patients as possible?

Would it be accurate to say that the military system is comparable to a

fictitious model of a PT employed by Medicare to treat only Medicare

patients? If this is an accurate comparison then it would be

advantageous for the employer/payer to dispel with much of the

regulatory guidelines and encourage the PT's to see as many patients as

possible since they are on a fixed salary? What an attractive business

model for the payer! (higher productivity per salary dollars spent)

If this is a somewhat accurate view of the reimbursement end of the

military system, then it cannot be accurately compared to private

practice. To me, the only attractive part of the military system would

be the decreased regulation and increased autonomy. What private

practice owner would want to increase their caseloads without a

concomitate increase in their income?

Am I looking at this all wrong? Forgive me if I'm totally off base

(pun intended). I'm trying to figure out how the military

reimbursement systmem compares to private industry and third party

payers.

Thanks,

Jon Mark Pleasant, PT

> >

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

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

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

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

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

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

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

ps.com<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.

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

com/promoclk/100126575x1218822736x1201267884/aol?

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

> 3D668072%26hmpgID

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

> >

> >

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Guest guest   

Guest guest
Posted

and Larry,

The exodus from private practice outpatient PT is probably divided

along an 'urban' vs. 'rural' fault line.

Anywhere high population densities give scale advantages to insurers

they have driven the average reimbursement down and Medicare is likely

the most profitable payer.

I hear anecdotal reports that midwestern practices see 10% Medicare

and are still getting $90-100 average per patient.

Here in Florida I am 60-70% Medicare, average reimbursement of $78 per

patient.

In the past 2 years I have sold two practice locations and slimmed

down to three (from seven) providers. I have 'fired' my 'below cost'

plans (United et al).

I still think a small practice can make money - even in these

recessionary times.

BTW, the recession has caused me a 33% drop in patient volume and a

25% drop in revenues (YoY Jan-Feb).

Private practice is not dying but it is changing - we are focusing

more on customer service, outcomes, and giving patients and doctors

what they want - we see walk-ins (PT STAT) and we advertise our

Balance & Falls Prevention Program.

Crises breed innovation and PTs are among the most innovative of all

the health care professions.

I predict that private practice PTs may prove to be among the most

innovative PTs in America, helping to solve our current health care

crisis.

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...

>

> > Rick,

> >

> > Locally, I have noticed that experienced therapists are opting to

go

> > into other settings that can provide them time off, stability and

> > increased salaries (particularly home care). I'm in NY, one of

the

> > worst reimbursing regions for third party payors, and have spoken

to

> > therapists about this. Although I have not researched/surveyed

it,

> > this is some of the data that I've come to know. Personally,

being

> > in OP for 8 years I couldn't do otherwise. Again, from a PT-PAC

> > viewpoint, I can't help bit wonder how our lobbying powers would

> > change positions if more PT's (only 13 percent of PT's do-

national)

> > contributed to the PAC.

> > Vinod

> > Sent from my BlackBerry® smartphone with SprintSpeed

> >

> > RE: Re: Scheduling Medicare Patients

> >

> >

> > It would be interesting to see if APTA or others have the data to

> > support the statement made by Larry that " but it is clear that

more

> > seasoned PT's are exiting outpatient for other settings rather

than

> > the opposite " . I personally do not see PT's with 10 years or

greater

> > of experience moving to the SNF setting or hospital inpatient

> > setting where the physical aspect of the job may be much more

> > demanding in terms of the physical limitations of the patients

(i.e.

> > bed mobility, transfers, etc.)

> >

> > I agree with Larry regarding all the demands on therapists now in

> > all outpatient settings. In addition to those in outpatient

> > settings, add in the " The Joint Commission " surveys, CARF surveys,

> > Press Ganey patient satisfaction surveys, etc. that mainly occur

in

> > hospitals, home health agencies, and SNF's, and not in the private

> > practice setting. Also add in the various State and CMS surveys

that

> > happen frequently in the before mentioned settings, either due to

> > yearly surveys or due to a patient/family complaint that usually

has

> > no merit. Those do not happen that often in the private practice

> > setting.

> >

> >

>

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Guest guest   

Guest guest
Posted

and Larry,

The exodus from private practice outpatient PT is probably divided

along an 'urban' vs. 'rural' fault line.

Anywhere high population densities give scale advantages to insurers

they have driven the average reimbursement down and Medicare is likely

the most profitable payer.

I hear anecdotal reports that midwestern practices see 10% Medicare

and are still getting $90-100 average per patient.

Here in Florida I am 60-70% Medicare, average reimbursement of $78 per

patient.

In the past 2 years I have sold two practice locations and slimmed

down to three (from seven) providers. I have 'fired' my 'below cost'

plans (United et al).

I still think a small practice can make money - even in these

recessionary times.

BTW, the recession has caused me a 33% drop in patient volume and a

25% drop in revenues (YoY Jan-Feb).

Private practice is not dying but it is changing - we are focusing

more on customer service, outcomes, and giving patients and doctors

what they want - we see walk-ins (PT STAT) and we advertise our

Balance & Falls Prevention Program.

Crises breed innovation and PTs are among the most innovative of all

the health care professions.

I predict that private practice PTs may prove to be among the most

innovative PTs in America, helping to solve our current health care

crisis.

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...

>

> > Rick,

> >

> > Locally, I have noticed that experienced therapists are opting to

go

> > into other settings that can provide them time off, stability and

> > increased salaries (particularly home care). I'm in NY, one of

the

> > worst reimbursing regions for third party payors, and have spoken

to

> > therapists about this. Although I have not researched/surveyed

it,

> > this is some of the data that I've come to know. Personally,

being

> > in OP for 8 years I couldn't do otherwise. Again, from a PT-PAC

> > viewpoint, I can't help bit wonder how our lobbying powers would

> > change positions if more PT's (only 13 percent of PT's do-

national)

> > contributed to the PAC.

> > Vinod

> > Sent from my BlackBerry® smartphone with SprintSpeed

> >

> > RE: Re: Scheduling Medicare Patients

> >

> >

> > It would be interesting to see if APTA or others have the data to

> > support the statement made by Larry that " but it is clear that

more

> > seasoned PT's are exiting outpatient for other settings rather

than

> > the opposite " . I personally do not see PT's with 10 years or

greater

> > of experience moving to the SNF setting or hospital inpatient

> > setting where the physical aspect of the job may be much more

> > demanding in terms of the physical limitations of the patients

(i.e.

> > bed mobility, transfers, etc.)

> >

> > I agree with Larry regarding all the demands on therapists now in

> > all outpatient settings. In addition to those in outpatient

> > settings, add in the " The Joint Commission " surveys, CARF surveys,

> > Press Ganey patient satisfaction surveys, etc. that mainly occur

in

> > hospitals, home health agencies, and SNF's, and not in the private

> > practice setting. Also add in the various State and CMS surveys

that

> > happen frequently in the before mentioned settings, either due to

> > yearly surveys or due to a patient/family complaint that usually

has

> > no merit. Those do not happen that often in the private practice

> > setting.

> >

> >

>

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Guest guest   

Guest guest
Posted

and Larry,

The exodus from private practice outpatient PT is probably divided

along an 'urban' vs. 'rural' fault line.

Anywhere high population densities give scale advantages to insurers

they have driven the average reimbursement down and Medicare is likely

the most profitable payer.

I hear anecdotal reports that midwestern practices see 10% Medicare

and are still getting $90-100 average per patient.

Here in Florida I am 60-70% Medicare, average reimbursement of $78 per

patient.

In the past 2 years I have sold two practice locations and slimmed

down to three (from seven) providers. I have 'fired' my 'below cost'

plans (United et al).

I still think a small practice can make money - even in these

recessionary times.

BTW, the recession has caused me a 33% drop in patient volume and a

25% drop in revenues (YoY Jan-Feb).

Private practice is not dying but it is changing - we are focusing

more on customer service, outcomes, and giving patients and doctors

what they want - we see walk-ins (PT STAT) and we advertise our

Balance & Falls Prevention Program.

Crises breed innovation and PTs are among the most innovative of all

the health care professions.

I predict that private practice PTs may prove to be among the most

innovative PTs in America, helping to solve our current health care

crisis.

Tim , PT

www.PhysicalTherapyDiagnosis.com

TimRichPT@...

>

> > Rick,

> >

> > Locally, I have noticed that experienced therapists are opting to

go

> > into other settings that can provide them time off, stability and

> > increased salaries (particularly home care). I'm in NY, one of

the

> > worst reimbursing regions for third party payors, and have spoken

to

> > therapists about this. Although I have not researched/surveyed

it,

> > this is some of the data that I've come to know. Personally,

being

> > in OP for 8 years I couldn't do otherwise. Again, from a PT-PAC

> > viewpoint, I can't help bit wonder how our lobbying powers would

> > change positions if more PT's (only 13 percent of PT's do-

national)

> > contributed to the PAC.

> > Vinod

> > Sent from my BlackBerry® smartphone with SprintSpeed

> >

> > RE: Re: Scheduling Medicare Patients

> >

> >

> > It would be interesting to see if APTA or others have the data to

> > support the statement made by Larry that " but it is clear that

more

> > seasoned PT's are exiting outpatient for other settings rather

than

> > the opposite " . I personally do not see PT's with 10 years or

greater

> > of experience moving to the SNF setting or hospital inpatient

> > setting where the physical aspect of the job may be much more

> > demanding in terms of the physical limitations of the patients

(i.e.

> > bed mobility, transfers, etc.)

> >

> > I agree with Larry regarding all the demands on therapists now in

> > all outpatient settings. In addition to those in outpatient

> > settings, add in the " The Joint Commission " surveys, CARF surveys,

> > Press Ganey patient satisfaction surveys, etc. that mainly occur

in

> > hospitals, home health agencies, and SNF's, and not in the private

> > practice setting. Also add in the various State and CMS surveys

that

> > happen frequently in the before mentioned settings, either due to

> > yearly surveys or due to a patient/family complaint that usually

has

> > no merit. Those do not happen that often in the private practice

> > setting.

> >

> >

>

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Guest guest   

Guest guest
Posted

Rick and Group,

Rick says below. " Non-Medicare payers will follow the definition of 'each 15

minutes' of which you must do a substantial portion to bill " . Can anyone tell

me how much is a substantial portion? Although the AMA defines CPT codes, I am

unable to find any definition of " substantial portion " .

Thank you in advance,

Christen, PT

Facility Manager

Genesis Physical Therapy at Crow Valley

Genesis Physical Rehabilitation at King Plaza

2300 53rd Ave, Suite LL02

Bettendorf, IA 52722

fax

>>> " Rick Gawenda " 02/23/2009 06:20 AM >>>

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

>

>

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Guest guest   

Guest guest
Posted

Rick and Group,

Rick says below. " Non-Medicare payers will follow the definition of 'each 15

minutes' of which you must do a substantial portion to bill " . Can anyone tell

me how much is a substantial portion? Although the AMA defines CPT codes, I am

unable to find any definition of " substantial portion " .

Thank you in advance,

Christen, PT

Facility Manager

Genesis Physical Therapy at Crow Valley

Genesis Physical Rehabilitation at King Plaza

2300 53rd Ave, Suite LL02

Bettendorf, IA 52722

fax

>>> " Rick Gawenda " 02/23/2009 06:20 AM >>>

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

>

>

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Guest guest   

Guest guest
Posted

During this discussion there has been brought up services that are deligated

to Techs and Aides. What components of the therapy session do those who

feel that this is possible deligate. Is it supervision of exercises in the

gym with patient flow sheet, or delivering US treatments, EGS treatments and

such.

Steve Marcum PT

Outpatient Clinic

Lexington, KY

On Wed, Mar 4, 2009 at 12:31 PM, Christen <christenk@...

> wrote:

> Rick and Group,

>

> Rick says below. " Non-Medicare payers will follow the definition of 'each

> 15 minutes' of which you must do a substantial portion to bill " . Can anyone

> tell me how much is a substantial portion? Although the AMA defines CPT

> codes, I am unable to find any definition of " substantial portion " .

>

> Thank you in advance,

>

>

> Christen, PT

> Facility Manager

> Genesis Physical Therapy at Crow Valley

> Genesis Physical Rehabilitation at King Plaza

> 2300 53rd Ave, Suite LL02

> Bettendorf, IA 52722

>

> fax

>

> >>> " Rick Gawenda " <rick0905@... <rick0905%40yahoo.com>> 02/23/2009

> 06:20 AM >>>

> 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

> >

> >

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Guest guest   

Guest guest
Posted

During this discussion there has been brought up services that are deligated

to Techs and Aides. What components of the therapy session do those who

feel that this is possible deligate. Is it supervision of exercises in the

gym with patient flow sheet, or delivering US treatments, EGS treatments and

such.

Steve Marcum PT

Outpatient Clinic

Lexington, KY

On Wed, Mar 4, 2009 at 12:31 PM, Christen <christenk@...

> wrote:

> Rick and Group,

>

> Rick says below. " Non-Medicare payers will follow the definition of 'each

> 15 minutes' of which you must do a substantial portion to bill " . Can anyone

> tell me how much is a substantial portion? Although the AMA defines CPT

> codes, I am unable to find any definition of " substantial portion " .

>

> Thank you in advance,

>

>

> Christen, PT

> Facility Manager

> Genesis Physical Therapy at Crow Valley

> Genesis Physical Rehabilitation at King Plaza

> 2300 53rd Ave, Suite LL02

> Bettendorf, IA 52722

>

> fax

>

> >>> " Rick Gawenda " <rick0905@... <rick0905%40yahoo.com>> 02/23/2009

> 06:20 AM >>>

> 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

> >

> >

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