Re: Hosp-based Off-Site Outpatient Rehab Supervision

[Guest guest]

Armin,

Actually I do know the difference between profit and loss. We

actually are about $600K short each year in the department, after

covering our department expenses. We can never meet the expenses and

margins that the hospital places on us to help support the entire

system. I know that Medicare is a better payor in some places, but we

are predominently Medicaid. I am trying to make the point that where

private practice owners feel that the playing field isn't level when

going against hospitals, I believe that it can go against us, especially

for the non profits. Private practice owners usually do not have a

whole hospital, let alone a system to support with what they make.

But....if this was a private practice, we would be making a profit.

Tom Kaluzny PT

Rehabilitation Services Manager

Providence Mount Carmel Hospital

982 E. Columbia

Colville, WA 99114

Work:

Fax:

email: thomas.kaluzny@...

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of Armin Loges, PT

Sent: Tuesday, November 17, 2009 2:12 PM

To: PTManager

Subject: Re: Hosp-based Off-Site Outpatient Rehab

Supervision

Tom:

I am not presuming to know. Much to the contrary...

So, what you are saying is that, after covering all the PT dept.

expenses, pay roll, rent, etc etc, there are still moneys from PT to

support other departments?

That, in PP world would be considered profit, would not? Which

contradicts what others have submitted about hospitals not profiting

from PT.

In many areas, for private practice, Medicare is the better payer.

Sincerely:

Armin Loges, PT

Tampa, FL

From: Kaluzny, R.

Sent: Tuesday, November 17, 2009 2:20 PM

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

Subject: RE: Hosp-based Off-Site Outpatient Rehab

Supervision

Good Morning,

As a non profit, hospital based, rural outpatient PT service, I

think that there is another aspect to this line. While we do have to

compete with other private practices, eighty two percent of our

referrals are Medicare and Medicaid. Our local physicians refer mainly

those patient populations to us since we are non profit. We do not see

the higher end payors. This makes it very difficult for us to maintain

our margin. We are responsible for a nearly 7 figure margin to support

the other hospital based services (we are off site and have to pay our

own rent, cleaning, utilities, etc) and then are responsible for helping

to maintain the other services. We have been unable to meet our margin

responsibiltiy in the 7 years I have been manager. I was in private

practice for 10 years and have found it much harder to try and maintain

profitability in a hospital setting than I ever did in private practice.

Our productivity is at 107%, with overtime, so it is not a lack of

patients, just the patient mix since we are a non profit hospital.

Tom Kaluzny PT

Rehabilitation Services Manager

Providence Mount Carmel Hospital

982 E. Columbia

Colville, WA 99114

Work:

Fax:

email: thomas.kaluzny@...

<mailto:thomas.kaluzny%40providence.org>

[Guest guest]

Armin,

Actually I do know the difference between profit and loss. We

actually are about $600K short each year in the department, after

covering our department expenses. We can never meet the expenses and

margins that the hospital places on us to help support the entire

system. I know that Medicare is a better payor in some places, but we

are predominently Medicaid. I am trying to make the point that where

private practice owners feel that the playing field isn't level when

going against hospitals, I believe that it can go against us, especially

for the non profits. Private practice owners usually do not have a

whole hospital, let alone a system to support with what they make.

But....if this was a private practice, we would be making a profit.

Tom Kaluzny PT

Rehabilitation Services Manager

Providence Mount Carmel Hospital

982 E. Columbia

Colville, WA 99114

Work:

Fax:

email: thomas.kaluzny@...

________________________________

From: PTManager [mailto:PTManager ] On

Behalf Of Armin Loges, PT

Sent: Tuesday, November 17, 2009 2:12 PM

To: PTManager

Subject: Re: Hosp-based Off-Site Outpatient Rehab

Supervision

Tom:

I am not presuming to know. Much to the contrary...

So, what you are saying is that, after covering all the PT dept.

expenses, pay roll, rent, etc etc, there are still moneys from PT to

support other departments?

That, in PP world would be considered profit, would not? Which

contradicts what others have submitted about hospitals not profiting

from PT.

In many areas, for private practice, Medicare is the better payer.

Sincerely:

Armin Loges, PT

Tampa, FL

From: Kaluzny, R.

Sent: Tuesday, November 17, 2009 2:20 PM

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

Subject: RE: Hosp-based Off-Site Outpatient Rehab

Supervision

Good Morning,

As a non profit, hospital based, rural outpatient PT service, I

think that there is another aspect to this line. While we do have to

compete with other private practices, eighty two percent of our

referrals are Medicare and Medicaid. Our local physicians refer mainly

those patient populations to us since we are non profit. We do not see

the higher end payors. This makes it very difficult for us to maintain

our margin. We are responsible for a nearly 7 figure margin to support

the other hospital based services (we are off site and have to pay our

own rent, cleaning, utilities, etc) and then are responsible for helping

to maintain the other services. We have been unable to meet our margin

responsibiltiy in the 7 years I have been manager. I was in private

practice for 10 years and have found it much harder to try and maintain

profitability in a hospital setting than I ever did in private practice.

Our productivity is at 107%, with overtime, so it is not a lack of

patients, just the patient mix since we are a non profit hospital.

Tom Kaluzny PT

Rehabilitation Services Manager

Providence Mount Carmel Hospital

982 E. Columbia

Colville, WA 99114

Work:

Fax:

email: thomas.kaluzny@...

<mailto:thomas.kaluzny%40providence.org>

[Guest guest]

Ditto for our department (we are a not-for-profit). If you just look at

our book of business, that is net revenue and actual expenses, we barely

break even. Medicare is one of our better payors as well, and comprises

30-40% of our business. The hospital assigns margin or overhead, which

is the amount the hospital expects us to contribute to the system. When

you add in the overhead, we are a huge money loser for the hospital. I

think you'll find that is the case in many hospital systems. I know that

is the case statewide here. Some hospitals are seriously considering

divesting themselves of rehab for that very reason. We are a major

expense. One hospital in our region got rid of all their rehab and

contracted with a corprate. Much cheaper for their bottom line. Not

saying this is a good idea, but it is reality.

Meryl Freeman, MS PT

Manager, Outpatient Rehab

Rex Healthcare

Raleigh, NC

RE: Hosp-based Off-Site Outpatient Rehab

Supervision

Good Morning,

As a non profit, hospital based, rural outpatient PT service, I

think that there is another aspect to this line. While we do

have to

compete with other private practices, eighty two percent of our

referrals are Medicare and Medicaid. Our local physicians refer

mainly

those patient populations to us since we are non profit. We do

not see

the higher end payors. This makes it very difficult for us to

maintain

our margin. We are responsible for a nearly 7 figure margin to

support

the other hospital based services (we are off site and have to

pay our

own rent, cleaning, utilities, etc) and then are responsible for

helping

to maintain the other services. We have been unable to meet our

margin

responsibiltiy in the 7 years I have been manager. I was in

private

practice for 10 years and have found it much harder to try and

maintain

profitability in a hospital setting than I ever did in private

practice.

Our productivity is at 107%, with overtime, so it is not a lack

of

patients, just the patient mix since we are a non profit

hospital.

Tom Kaluzny PT

Rehabilitation Services Manager

Providence Mount Carmel Hospital

982 E. Columbia

Colville, WA 99114

Work:

Fax:

email: thomas.kaluzny@...

<mailto:thomas.kaluzny%40providence.org>

<mailto:thomas.kaluzny%40providence.org>

[Guest guest]

Ditto for our department (we are a not-for-profit). If you just look at

our book of business, that is net revenue and actual expenses, we barely

break even. Medicare is one of our better payors as well, and comprises

30-40% of our business. The hospital assigns margin or overhead, which

is the amount the hospital expects us to contribute to the system. When

you add in the overhead, we are a huge money loser for the hospital. I

think you'll find that is the case in many hospital systems. I know that

is the case statewide here. Some hospitals are seriously considering

divesting themselves of rehab for that very reason. We are a major

expense. One hospital in our region got rid of all their rehab and

contracted with a corprate. Much cheaper for their bottom line. Not

saying this is a good idea, but it is reality.

Meryl Freeman, MS PT

Manager, Outpatient Rehab

Rex Healthcare

Raleigh, NC

RE: Hosp-based Off-Site Outpatient Rehab

Supervision

Good Morning,

As a non profit, hospital based, rural outpatient PT service, I

think that there is another aspect to this line. While we do

have to

compete with other private practices, eighty two percent of our

referrals are Medicare and Medicaid. Our local physicians refer

mainly

those patient populations to us since we are non profit. We do

not see

the higher end payors. This makes it very difficult for us to

maintain

our margin. We are responsible for a nearly 7 figure margin to

support

the other hospital based services (we are off site and have to

pay our

own rent, cleaning, utilities, etc) and then are responsible for

helping

to maintain the other services. We have been unable to meet our

margin

responsibiltiy in the 7 years I have been manager. I was in

private

practice for 10 years and have found it much harder to try and

maintain

profitability in a hospital setting than I ever did in private

practice.

Our productivity is at 107%, with overtime, so it is not a lack

of

patients, just the patient mix since we are a non profit

hospital.

Tom Kaluzny PT

Rehabilitation Services Manager

Providence Mount Carmel Hospital

982 E. Columbia

Colville, WA 99114

Work:

Fax:

email: thomas.kaluzny@...

<mailto:thomas.kaluzny%40providence.org>

<mailto:thomas.kaluzny%40providence.org>

[Guest guest]

Ditto for our department (we are a not-for-profit). If you just look at

our book of business, that is net revenue and actual expenses, we barely

break even. Medicare is one of our better payors as well, and comprises

30-40% of our business. The hospital assigns margin or overhead, which

is the amount the hospital expects us to contribute to the system. When

you add in the overhead, we are a huge money loser for the hospital. I

think you'll find that is the case in many hospital systems. I know that

is the case statewide here. Some hospitals are seriously considering

divesting themselves of rehab for that very reason. We are a major

expense. One hospital in our region got rid of all their rehab and

contracted with a corprate. Much cheaper for their bottom line. Not

saying this is a good idea, but it is reality.

Meryl Freeman, MS PT

Manager, Outpatient Rehab

Rex Healthcare

Raleigh, NC

RE: Hosp-based Off-Site Outpatient Rehab

Supervision

Good Morning,

As a non profit, hospital based, rural outpatient PT service, I

think that there is another aspect to this line. While we do

have to

compete with other private practices, eighty two percent of our

referrals are Medicare and Medicaid. Our local physicians refer

mainly

those patient populations to us since we are non profit. We do

not see

the higher end payors. This makes it very difficult for us to

maintain

our margin. We are responsible for a nearly 7 figure margin to

support

the other hospital based services (we are off site and have to

pay our

own rent, cleaning, utilities, etc) and then are responsible for

helping

to maintain the other services. We have been unable to meet our

margin

responsibiltiy in the 7 years I have been manager. I was in

private

practice for 10 years and have found it much harder to try and

maintain

profitability in a hospital setting than I ever did in private

practice.

Our productivity is at 107%, with overtime, so it is not a lack

of

patients, just the patient mix since we are a non profit

hospital.

Tom Kaluzny PT

Rehabilitation Services Manager

Providence Mount Carmel Hospital

982 E. Columbia

Colville, WA 99114

Work:

Fax:

email: thomas.kaluzny@...

<mailto:thomas.kaluzny%40providence.org>

<mailto:thomas.kaluzny%40providence.org>

[Guest guest]

I think the biggest challenge we face is providing services for charity care

which negates our bottom line and over the past one year charity care has gone

up. I don't know what the answer is.

 

Pam Eluri,PT,MS

Subject: RE: Hosp-based Off-Site Outpatient Rehab Supervision

To: PTManager

Date: Tuesday, November 17, 2009, 10:19 PM

 

Ditto for our department (we are a not-for-profit) . If you just look at

our book of business, that is net revenue and actual expenses, we barely

break even. Medicare is one of our better payors as well, and comprises

30-40% of our business. The hospital assigns margin or overhead, which

is the amount the hospital expects us to contribute to the system. When

you add in the overhead, we are a huge money loser for the hospital. I

think you'll find that is the case in many hospital systems. I know that

is the case statewide here. Some hospitals are seriously considering

divesting themselves of rehab for that very reason. We are a major

expense. One hospital in our region got rid of all their rehab and

contracted with a corprate. Much cheaper for their bottom line. Not

saying this is a good idea, but it is reality.

Meryl Freeman, MS PT

Manager, Outpatient Rehab

Rex Healthcare

Raleigh, NC

RE: Hosp-based Off-Site Outpatient Rehab

Supervision

Good Morning,

As a non profit, hospital based, rural outpatient PT service, I

think that there is another aspect to this line. While we do

have to

compete with other private practices, eighty two percent of our

referrals are Medicare and Medicaid. Our local physicians refer

mainly

those patient populations to us since we are non profit. We do

not see

the higher end payors. This makes it very difficult for us to

maintain

our margin. We are responsible for a nearly 7 figure margin to

support

the other hospital based services (we are off site and have to

pay our

own rent, cleaning, utilities, etc) and then are responsible for

helping

to maintain the other services. We have been unable to meet our

margin

responsibiltiy in the 7 years I have been manager. I was in

private

practice for 10 years and have found it much harder to try and

maintain

profitability in a hospital setting than I ever did in private

practice.

Our productivity is at 107%, with overtime, so it is not a lack

of

patients, just the patient mix since we are a non profit

hospital.

Tom Kaluzny PT

Rehabilitation Services Manager

Providence Mount Carmel Hospital

982 E. Columbia

Colville, WA 99114

Work:

Fax:

email: thomas.kaluzny@ providence. org

<mailto:thomas. kaluzny%40provid ence.org>

<mailto:thomas. kaluzny%40provid ence.org>

[Guest guest]

Group:

I think there is a little bit of misunderstanding here, and perhaps I did not

get my point across.

None of this has to do with us vs. them (or vice versa, private practice vs.

hospital and so on).

We are all PTs and should, in one way or another, " play on the same team " .

That is, in my opinion, what we don't do.

I can feel through some of these posts, some get quite offended - which is fine.

Not my intention to offend, but is part of any debate.

IN ANY RATE...my ORIGINAL point being we as ONE profession are dealt LIKE we are

many different professions, depending on who we are working for: I am talking

about regulation. But also rate of reimbursement. We are all apples, but are

dealt like bananas, apples, oranges, cucumbers, and on and on. And most of us

seem to think is ok and its how it has always been and how it will always be.

This sheepish attitude bothers me, I must confess. Nonetheless, I know hospital

based, private practice, Nursing home, etc etc, we all have our challenges and

no one is in any privileged situation. What I mean is that we all should really

have to have the same challenges, because we are really all PTs. We don't

because we are not the ones deciding what we do. Everybody else is doing it for

us. It meant it to be a quick remark. Not a debate, but ok.

ON ANOTHER NOTE, regardless (or aside of) of cost shifting, I been reading

opposing remarks from the hospital based folks. (THIS IS NOT CRITICISM. MORE OF

A QUESTION). It seems in some places PT is carrying the load (paying the bills)

and in some is being the black hole. I would like to hear more about that from

the guys from hospital based outpatient.

Sincerely;

Armin Loges, PT

Tampa, FL

From: Freeman, Meryl

Sent: Tuesday, November 17, 2009 10:19 PM

To: PTManager

Subject: RE: Hosp-based Off-Site Outpatient Rehab Supervision

Ditto for our department (we are a not-for-profit). If you just look at

our book of business, that is net revenue and actual expenses, we barely

break even. Medicare is one of our better payors as well, and comprises

30-40% of our business. The hospital assigns margin or overhead, which

is the amount the hospital expects us to contribute to the system. When

you add in the overhead, we are a huge money loser for the hospital. I

think you'll find that is the case in many hospital systems. I know that

is the case statewide here. Some hospitals are seriously considering

divesting themselves of rehab for that very reason. We are a major

expense. One hospital in our region got rid of all their rehab and

contracted with a corprate. Much cheaper for their bottom line. Not

saying this is a good idea, but it is reality.

Meryl Freeman, MS PT

Manager, Outpatient Rehab

Rex Healthcare

Raleigh, NC

RE: Hosp-based Off-Site Outpatient Rehab

Supervision

Good Morning,

As a non profit, hospital based, rural outpatient PT service, I

think that there is another aspect to this line. While we do

have to

compete with other private practices, eighty two percent of our

referrals are Medicare and Medicaid. Our local physicians refer

mainly

those patient populations to us since we are non profit. We do

not see

the higher end payors. This makes it very difficult for us to

maintain

our margin. We are responsible for a nearly 7 figure margin to

support

the other hospital based services (we are off site and have to

pay our

own rent, cleaning, utilities, etc) and then are responsible for

helping

to maintain the other services. We have been unable to meet our

margin

responsibiltiy in the 7 years I have been manager. I was in

private

practice for 10 years and have found it much harder to try and

maintain

profitability in a hospital setting than I ever did in private

practice.

Our productivity is at 107%, with overtime, so it is not a lack

of

patients, just the patient mix since we are a non profit

hospital.

Tom Kaluzny PT

Rehabilitation Services Manager

Providence Mount Carmel Hospital

982 E. Columbia

Colville, WA 99114

Work:

Fax:

email: thomas.kaluzny@...

<mailto:thomas.kaluzny%40providence.org>

<mailto:thomas.kaluzny%40providence.org>

[Guest guest]

Hi Meryl and All..

Hospital based PT depts. do and should make a profit - whether they are

not-for-profit or otherwise. we cant control the cost shifting that occurs at

the accounting level of the hospital - the fact remains, OP hospital PT depts

make $ - that is why they are a target for outside contractors - the inpatient

DRG simply isn't attractive in mostc ases. Keep in mind that most hospitals have

managed care contracts that pay a % of charges which allows the hospital to take

a disproportionate amount of self pays (non-pay) and lower payors like Medicaid.

All docs know that rehab folks 'count' referrals and many try to be 'fair' in

their communities by spreading the referrals around to each PT provider, be it a

PP or corporate or hospital. Since the hospital PT dept takes Medicaid,

charity, and self-pays, the docs, who know that well, tend to refer the lower

paying spectrum to the hospital This results in a lesser quality payer mix than

the other competitors in town. So actually, non hospital providers get an

artificial boost, if you will. Also, hospitals are quickly moving away from a

volume based accounting system (units, without regard for collections, for

instance), and moving towards real world net revenue, much like a PP. It no

longer makes any sense for hospital PT's to continue the old school focus of

'units billed' when there remains a disproportionate lower quality payor mix

adding to the decline of net revenue. Another point is that hospital PT

departments are sometimes hindered in gaining referrals because docs 'strike

back' at the hospital for things that have absolutely nothing to do with the

access to or quality of PT care there - corporates or PP don't have that

problem. So, it is a tough world out there, but hospital PT will not only

survive, but make significant gains on competitors in their locales as they are

able to attract and retain quality PT's. The trick is to do this collegiality

in each of our communities - the real enemy is not each other, but docs in

non-direct access/reimbursement states that continually bring the service

in-house. Medicare direct access is the single most important thing that can

happen next - when that happens - then the playing field is more level and the

setting matters less, and then, may the best PT win!

Don Walsh, PT, MS, OCS

Northeast Georgia Medical Center

Gainesville, GA

>

> Ditto for our department (we are a not-for-profit). If you just look at

> our book of business, that is net revenue and actual expenses, we barely

> break even. Medicare is one of our better payors as well, and comprises

> 30-40% of our business. The hospital assigns margin or overhead, which

> is the amount the hospital expects us to contribute to the system. When

> you add in the overhead, we are a huge money loser for the hospital. I

> think you'll find that is the case in many hospital systems. I know that

> is the case statewide here. Some hospitals are seriously considering

> divesting themselves of rehab for that very reason. We are a major

> expense. One hospital in our region got rid of all their rehab and

> contracted with a corprate. Much cheaper for their bottom line. Not

> saying this is a good idea, but it is reality.

>

>

> Meryl Freeman, MS PT

> Manager, Outpatient Rehab

> Rex Healthcare

> Raleigh, NC

>

>

>

>

>

> RE: Hosp-based Off-Site Outpatient Rehab

> Supervision

>

> Good Morning,

> As a non profit, hospital based, rural outpatient PT service, I

> think that there is another aspect to this line. While we do

> have to

> compete with other private practices, eighty two percent of our

> referrals are Medicare and Medicaid. Our local physicians refer

> mainly

> those patient populations to us since we are non profit. We do

> not see

> the higher end payors. This makes it very difficult for us to

> maintain

> our margin. We are responsible for a nearly 7 figure margin to

> support

> the other hospital based services (we are off site and have to

> pay our

> own rent, cleaning, utilities, etc) and then are responsible for

> helping

> to maintain the other services. We have been unable to meet our

> margin

> responsibiltiy in the 7 years I have been manager. I was in

> private

> practice for 10 years and have found it much harder to try and

> maintain

> profitability in a hospital setting than I ever did in private

> practice.

> Our productivity is at 107%, with overtime, so it is not a lack

> of

> patients, just the patient mix since we are a non profit

> hospital.

>

> Tom Kaluzny PT

> Rehabilitation Services Manager

> Providence Mount Carmel Hospital

> 982 E. Columbia

> Colville, WA 99114

> Work:

> Fax:

> email: thomas.kaluzny@...

> <mailto:thomas.kaluzny%40providence.org>

> <mailto:thomas.kaluzny%40providence.org>

>

>

[Guest guest]

Meryl,

I direct a hospital based department, although our hospital is very small and we

see about 80% outpatient load compared to only 20% inpatient. We make a profit

as long as our volume stays consistently high. that is the key, and we strive

to " earn " this volume through " word of mouth " among the patients we serve by

providing high quality of care.

Matt Dvorak, PT

Yankton, SD

________________________________

From: PTManager on behalf of Freeman, Meryl

Sent: Tue 11/17/2009 8:45 AM

To: PTManager

Subject: RE: Hosp-based Off-Site Outpatient Rehab Supervision

Armin:

I work in a hospital outpatient setting and I can tell you with

certainty that the hospital does not make any money from our services.

Like all other outpatient settings who bill legally and ethically, we

are very lucky if we break even. We are not a profit center for the

hospital and are considered one of those necessary services that will

not get much attention or capital, but exists only to provide the

service. Our hospital does not employ physicians that refer to PT and we

are out there competing with private practices, corporates, and POPTS

for patients just like you are.

We are subject to the same expense/revenue issues you are. Salaries and

non-controllable expenses are going up, reimbursement is going down.

These are major issues that we all share. They are issues we all need to

address as a profession.

As for the non-cap with hospitals, my understanding was that CMS based

this on a utilization study that showed overall hospital-based

utilization of PT was less than that of the private sector. I could be

mistaken. I agree with you that private practice may be at a

disadvantage with negotiations for reimbursement, etc, but I can tell

you that as a profession, we are all struggling with the same issues.

I honestly don't know how anyone, private practice or otherwise, makes

any profit. Change of subject here, but is anyone out there doing more

than breaking even while practicing/billing in an ethical manner? If

so, I'd sure like to hear about your model.

Regards,

Meryl W. Freeman, MS PT

Manager, Outpatient Rehab

Raleigh, NC

Hosp-based Off-Site Outpatient Rehab Supervision

To: PTManager@yahoogrou ps.com

Date: Wednesday, November 11, 2009, 9:00 PM

Hello Group,

I've recently joined a health system which includes one hospital-based,

off-site outpatient physical and occupational therapy clinic. I've been

informed by our Risk manager that Medicare requires on-site physician

supervision, meaning that a physician must be in the building whenever a

Medicare client is seen for therapy. According to her, this was a

Medicare

ruling in 2001. (In fact, she is following a discussion that indicates

the

ruling was misinterpreted all this time and really means that the

physician

must be in the room!) This apparently doesn't apply to non-hospital-

based

outpatient centers, and any on-site centers are assumed to have a

physician

in the Emergency Department. I have worked in both the private practice

and

hospital arenas, including hospital-based, off-site outpatient therapy

centers and I've never heard of this ruling before. In fact, many

centers

I'm aware of don't have a physician for miles. My questions to the

group:

- Have you ever heard of this ruling or discussion before?

- Does your hospital have off-site outpatient therapy and if so, how do

you

meet this requirement while still providing access for extended hours

(evenings, weekends, etc)?

- Is APTA/AOTA involved in this discussion? I haven't heard anything.

Any feedback is appreciated! I do have copies (pdf files) of letters

discussing the ruling, etc if you're interested.

Christen, PT

Kchristen1fhn (DOT) org

Director of Rehabilitation Services

FHN

Freeport, IL

[Guest guest]

Meryl,

I direct a hospital based department, although our hospital is very small and we

see about 80% outpatient load compared to only 20% inpatient. We make a profit

as long as our volume stays consistently high. that is the key, and we strive

to " earn " this volume through " word of mouth " among the patients we serve by

providing high quality of care.

Matt Dvorak, PT

Yankton, SD

________________________________

From: PTManager on behalf of Freeman, Meryl

Sent: Tue 11/17/2009 8:45 AM

To: PTManager

Subject: RE: Hosp-based Off-Site Outpatient Rehab Supervision

Armin:

I work in a hospital outpatient setting and I can tell you with

certainty that the hospital does not make any money from our services.

Like all other outpatient settings who bill legally and ethically, we

are very lucky if we break even. We are not a profit center for the

hospital and are considered one of those necessary services that will

not get much attention or capital, but exists only to provide the

service. Our hospital does not employ physicians that refer to PT and we

are out there competing with private practices, corporates, and POPTS

for patients just like you are.

We are subject to the same expense/revenue issues you are. Salaries and

non-controllable expenses are going up, reimbursement is going down.

These are major issues that we all share. They are issues we all need to

address as a profession.

As for the non-cap with hospitals, my understanding was that CMS based

this on a utilization study that showed overall hospital-based

utilization of PT was less than that of the private sector. I could be

mistaken. I agree with you that private practice may be at a

disadvantage with negotiations for reimbursement, etc, but I can tell

you that as a profession, we are all struggling with the same issues.

I honestly don't know how anyone, private practice or otherwise, makes

any profit. Change of subject here, but is anyone out there doing more

than breaking even while practicing/billing in an ethical manner? If

so, I'd sure like to hear about your model.

Regards,

Meryl W. Freeman, MS PT

Manager, Outpatient Rehab

Raleigh, NC

Hosp-based Off-Site Outpatient Rehab Supervision

To: PTManager@yahoogrou ps.com

Date: Wednesday, November 11, 2009, 9:00 PM

Hello Group,

I've recently joined a health system which includes one hospital-based,

off-site outpatient physical and occupational therapy clinic. I've been

informed by our Risk manager that Medicare requires on-site physician

supervision, meaning that a physician must be in the building whenever a

Medicare client is seen for therapy. According to her, this was a

Medicare

ruling in 2001. (In fact, she is following a discussion that indicates

the

ruling was misinterpreted all this time and really means that the

physician

must be in the room!) This apparently doesn't apply to non-hospital-

based

outpatient centers, and any on-site centers are assumed to have a

physician

in the Emergency Department. I have worked in both the private practice

and

hospital arenas, including hospital-based, off-site outpatient therapy

centers and I've never heard of this ruling before. In fact, many

centers

I'm aware of don't have a physician for miles. My questions to the

group:

- Have you ever heard of this ruling or discussion before?

- Does your hospital have off-site outpatient therapy and if so, how do

you

meet this requirement while still providing access for extended hours

(evenings, weekends, etc)?

- Is APTA/AOTA involved in this discussion? I haven't heard anything.

Any feedback is appreciated! I do have copies (pdf files) of letters

discussing the ruling, etc if you're interested.

Christen, PT

Kchristen1fhn (DOT) org

Director of Rehabilitation Services

FHN

Freeport, IL

[Guest guest]

Meryl,

I direct a hospital based department, although our hospital is very small and we

see about 80% outpatient load compared to only 20% inpatient. We make a profit

as long as our volume stays consistently high. that is the key, and we strive

to " earn " this volume through " word of mouth " among the patients we serve by

providing high quality of care.

Matt Dvorak, PT

Yankton, SD

________________________________

From: PTManager on behalf of Freeman, Meryl

Sent: Tue 11/17/2009 8:45 AM

To: PTManager

Subject: RE: Hosp-based Off-Site Outpatient Rehab Supervision

Armin:

I work in a hospital outpatient setting and I can tell you with

certainty that the hospital does not make any money from our services.

Like all other outpatient settings who bill legally and ethically, we

are very lucky if we break even. We are not a profit center for the

hospital and are considered one of those necessary services that will

not get much attention or capital, but exists only to provide the

service. Our hospital does not employ physicians that refer to PT and we

are out there competing with private practices, corporates, and POPTS

for patients just like you are.

We are subject to the same expense/revenue issues you are. Salaries and

non-controllable expenses are going up, reimbursement is going down.

These are major issues that we all share. They are issues we all need to

address as a profession.

As for the non-cap with hospitals, my understanding was that CMS based

this on a utilization study that showed overall hospital-based

utilization of PT was less than that of the private sector. I could be

mistaken. I agree with you that private practice may be at a

disadvantage with negotiations for reimbursement, etc, but I can tell

you that as a profession, we are all struggling with the same issues.

I honestly don't know how anyone, private practice or otherwise, makes

any profit. Change of subject here, but is anyone out there doing more

than breaking even while practicing/billing in an ethical manner? If

so, I'd sure like to hear about your model.

Regards,

Meryl W. Freeman, MS PT

Manager, Outpatient Rehab

Raleigh, NC

Hosp-based Off-Site Outpatient Rehab Supervision

To: PTManager@yahoogrou ps.com

Date: Wednesday, November 11, 2009, 9:00 PM

Hello Group,

I've recently joined a health system which includes one hospital-based,

off-site outpatient physical and occupational therapy clinic. I've been

informed by our Risk manager that Medicare requires on-site physician

supervision, meaning that a physician must be in the building whenever a

Medicare client is seen for therapy. According to her, this was a

Medicare

ruling in 2001. (In fact, she is following a discussion that indicates

the

ruling was misinterpreted all this time and really means that the

physician

must be in the room!) This apparently doesn't apply to non-hospital-

based

outpatient centers, and any on-site centers are assumed to have a

physician

in the Emergency Department. I have worked in both the private practice

and

hospital arenas, including hospital-based, off-site outpatient therapy

centers and I've never heard of this ruling before. In fact, many

centers

I'm aware of don't have a physician for miles. My questions to the

group:

- Have you ever heard of this ruling or discussion before?

- Does your hospital have off-site outpatient therapy and if so, how do

you

meet this requirement while still providing access for extended hours

(evenings, weekends, etc)?

- Is APTA/AOTA involved in this discussion? I haven't heard anything.

Any feedback is appreciated! I do have copies (pdf files) of letters

discussing the ruling, etc if you're interested.

Christen, PT

Kchristen1fhn (DOT) org

Director of Rehabilitation Services

FHN

Freeport, IL