Ok, just back from #PPS2015 and have a lot on my mind. Hopefully some of it is coherent.
PPS has an outstanding President and Board of Directors who are now deservedly subsidized. They put in a ton of work and have outlined a brave strategic plan. The annual breakfast business meeting was longer than Gone with the Wind but who is counting hours (or the mold that accumulated on the uneaten breakfast next to me after 3 hours).
For 25+ years of attending PPS or 29 years of APTA national meetings, I have noticed or heard a constant refrain:
“Embrace change” (PT doublespeak for reimbursement is going down and documentation requirements are going up)
“We have had a significant lobbying impact on healthcare payment reform” (PT doublespeak for a track record that rivals Seattle’s sports teams)
“We need to sell our value” (always a safe thing to say)
“You must wear these ribbons on your name tag to attend all events” (Can our profession ever get over this treatment of professionals like they are 7 year old swim heat participants?)
Overall though, great meeting. Congratulations to Dr. Carl DeRosa who was presented the Robert G. Dicus award, the sections most prestigious award (well deserved, Carl).
#PPS2015 had way too much content and choices which means most folks default to no choice and mostly hang out and network. When I first started going to PPS meetings in the late 1980’s, all meeting participants were a cohort and went to the same presentations as there were no choices or options and this is a concept that is worth revisiting.
While it is very clear that the APS debacle isn’t going to end anytime soon (see prior articles HERE), there are some areas like “selling value” that 100% of PT’s and affiliated groups can agree, namely that the regulatory and documentation requirements for PT’s are frankly obscene. Rather than list them in any type of order, let’s just address the biggest time sink which is the amount of disproportionate effort it takes to document an initial medicare visit. Recently, we surveyed PT’s in an outpatient environment about the amount of time it takes to document an initial evaluation on a non medicare patient and a medicare patient. Regardless of which EMR (and 6 different ones were represented), the average for an initial was 20 minutes and if the patient was medicare, the average increase in time was 15 minutes for total of 35 minutes. Yes, medicare patients who arguably have the greatest needs, have their PT’s spending a significant amount of time not on them but on their EMR. All of this to say, we can’t have meaningful payment reform without regulatory reform. Said differently, regulatory reform is payment reform.
Loss aversion states that PT’s are more driven by fear by not documenting correctly than they are jazzed up to do what is right for the patient. We often forget that few become PT’s so that they can aspire to be the most compliant PT. Documentation has never improved patient care and because of gaming likely doesn’t even reflect it. Does anybody really believe that a PT should spend just as much time documenting as they do treating?
Dropping regulations does work. Best example? Ironically, it is medicare. In bundled payment initiatives within SNF and outpatient, medicare replacement capitation, and medicare replacement plans that don’t follow medicare rules, it is easy to observe PT’s spending more time on patients and less concerned with the myriad of documentation and regulatory requirements (e.g. 8 minute rule, explicit provider restriction, group therapy limitations). A practice gets better reimbursement by a medicare replacement patient at 90% of medicare fee schedule and no rules vs. 100% of traditional medicare and the current rules and requirements.
This same over regulation also dominates non medicare as well with the specialty benefit managers having their own superimposed “hoops and ladders” for pre-cert, supposed “outcomes” tools, forms, and documentation add ons. The combination of these constraints and depressors results in PT’s dissatisfaction, burnout, and disengagement. We must do better.
How about abandoning APS and APTA collaborate with stakeholder groups on meaningful regulatory reform prior to payment methodology reform?
How about APTA completely re-engineering their antiquated documentation standards and initiate that process with actually observing a PT documenting on an EMR-any EMR?
Challenge to all EMR companies-can a minimum data set be created that meets the majority of requirements and lowers all documentation to 2 minutes or less?
Winner gets a ribbon.
Thoughts?
@physicaltherapy