Physical Therapy Diagnosis

Sugar, Fat and Physical Therapy

2009-12-14T21:25:00.014-05:00

Can diet affect physical therapy outcomes?Does the typical 'American diet' - high fat, high sugar - lead to the expression of anxiety-related behaviors?University of South Florida researcher David Diamond, PhD recently found that a high carbohydrate/high fat diet caused 'avoidance behaviors' and anxiety among rats.Dr. Diamond presented his findings at the Society of Neuroscience meeting in

RACs Get Complex

2009-12-10T12:22:00.006-05:00

Up until now, Recovery Audit Contractors (RACs) have only been approved to issue demand letters for multiple, untimed codes: evaluation (97001)re-eval (97002)e-stim (G0283)traction (97012)etc ...per day per patient.The RACs would review your billing profile using computerized, 'data drilling robots' that spot these un-listed Common Procedural Terminology (CPT) code edits and send you a demand

For Physical Therapists: How NOT to think like a turkey

2009-12-05T15:54:00.015-05:00

Do you want to avoid thinking like a turkey?To NOT think like a turkey, first consider HOW turkey's think...It's the day after Thanksgiving and a newly hatched turkey has arrived.He has the coop to himself with plenty of room and no competition for food, etc.Then, some humans arrive at feeding time. They provide food and water.After that, they turn the lights down low, turn up the bed warmers

Can PTs make BETTER decisions than physicians?

2009-12-01T15:52:00.007-05:00

This International Classification on Functioning (ICF) video describes the unifying framework between the physician and the physical therapy frameworks by Gerold Stucki, MD at the University of Sydney in July 2009.The link to the video can be found within the World Confederation on Physical Therapy (WCF) December newsletter.Leaders in rehabilitation research aim to unify the Medical model (eg:

The RAC Demand Letter No Physical Therapist EVER wants to get

2009-12-01T09:43:00.005-05:00

Save yourself some time and money.Take this sample RAC demand letter to your physical therapist in private practice (PTPP) office manager and let them know this is TOP PRIORITY - if you get a demand for return of overpayment you have 15 days to respond.That's 15 days from the date in the upper left hand corner of the demand letter - not the date you find the letter in your mailbox. Here is the 4

How to Use Fear Avoidance Beliefs in your Physical Therapy Plan of Care

2009-11-13T08:17:00.026-05:00

We recently held a Treatment Based Classification Seminar (TBC) at our physical therapy clinic in Palmetto, Florida.Most of the physical therapists attending (14) had a fairly good awareness of TBC but one item stood out - Fear Avoidance Beliefs (FAB).None of the attending therapists used even the FAB 'clinical shortcut' in their evaluation:“I should not do physical activities which (might) make

How can we cut costs and improve outcomes in physical therapy?

2009-11-12T14:26:00.004-05:00

Since cost-cutting in healthcare is in the news recently I wanted to offer the physical therapist in private practice (PTPP) perspective - each cost-cutting measure is accompanied by a 'plus' (yes) or a 'slash' (no) according to whether or not I expect it to achieve its intended effect:Health Information Technology (HIT)/Electronic Medical Records (EMR)Most physical therapists will see a short

Medicare Experts Recommend Physical Therapists Get a Comparative Billing Report

2009-11-10T14:16:00.006-05:00

We've just completed the Classification Seminar with Special Guests Jim Needham, former CEO of a local physician owned physical therapy (POPTs) clinic and Belinda Holmes, healthcare auditor for accounting firm Kerkering Barberio on Saturday, November 7th.Our audience of physical therapists and physical therapist assistants was very interested in Jim's talk:"Competing with POPTs under Healthcare

Private Practice Physical Therapists will get RAC data from Belinda Holmes

2009-11-05T21:25:00.005-05:00

Belinda Holmes, BS, CPC, CCP-P will share her physical therapy RAC 'war stories' and tips to protect yourself from physical therapy automated claims review for 'untimed codes' in 2010.Belinda will present "Medicare Defense Strategies"in Palmetto at Medical Arts Rehabilitation, Inc from 9am to 3pm - Belinda's part begins at 10:30am -11:30am on Saturday, November 7th, 2009.Belinda works for

Docs won't be able to own physical therapy, says Jim.

2009-11-03T13:05:00.005-05:00

Physician Owned Physical Therapy (POPT) clinics may be on the way out in 2010 says Jim Needham, CEO.Jim will present his seminar..."Competing Against POPTs under Health Care Reform" ...in Palmetto, Florida on November 7th and 21st.Jim Needman is a healthcare consultant and former POPTs CEO so he should know what he is talking about. Jim's main premise is that physician practices will be unable to

Outpatient physical therapy and 17-page Medicare Evaluations

2009-10-29T13:22:00.005-04:00

Outpatient physical therapists get ready - you may soon have to perform 17-page Medicare initial evaluations like your brothers and sisters in home health care.The project Developing Outpatient Therapy Payment Alternatives (DOTPA) has issued these evaluation forms as 'prototypes' - presumably for provider input.The proposed evaluation forms are available from the Research Triangle International (

Is Health Care Fraud Inflated?

2009-10-27T15:25:00.010-04:00

Health care fraud costs Americans between $68 and $220 billion per year, according to a new report from the School of Public Health and Health Services at the George Washington University.The large gap in the estimation of fraud costs exists, in my opinion, because of the imprecise definition of fraud. Black’s Law Dictionary defines fraud as...“a knowing misrepresentation of the truth or

Three reasons why POPTs will give way to PTPP in 2010

2009-10-22T13:57:00.008-04:00

Just this week three things have happened that lead me to question the survivability of the physician-owned physical therapy (POPT) model in 2010.By the way, none of this seems to be directly affected by the direction of the health care reform debates - whichever way reform goes the POPT outcome seems destined to happen.ONEA Medicare Payment Advisory Commission (MedPAC) meeting October 8th

Heads Up! Physical Therapists in Private Practice (PTPP)

2009-10-19T18:55:00.007-04:00

The annual issuance of the Office of the Inspector General's (OIG) 2010 Work Plan sets the tempo for all subsequent Medicare audits - since the OIG is the agency that actually audits Medicare (CMS).Here is what the Work Plan actually says about physical therapists in private practice:"Outpatient Physical Therapy Services Provided by Independent TherapistsWe will review outpatient physical therapy

POPTs Leader Predicts Massive Sell-Off under Health Care Reform

2009-10-13T16:24:00.018-04:00

The Senate Finance Committee, on Tuesday October 13th, just voted 14-9 to move the fifth and final version of healthcare reform out of committee and back to the Senate for merger with more generous versions of health reform legislation passed earlier this year.The latest measure passed with a party line vote (Democrats outnumber Republicans 13-9 on the committee) - with Olympia Snowe (R-Maine)

How to Sell Physical Therapy

2009-10-06T09:11:00.008-04:00

How good are you at 'selling' your therapy?Can you 'close' the deal?Or, do you let the customer slip away?If your customer slips away does another, better 'marketed' professional (MD ortho, DC, Pain doc, etc.) provide the care they need?Maybe physical therapists should consider how we position ourselves when it comes time to 'close the sale' - according to Israeli researchers using American

Physical Therapy, Silver Coins and Green Eyeshades

2009-09-29T20:11:00.019-04:00

We need a common coin of the realm.After Napoleon's final defeat at the Battle of Waterloo on June 18, 1815 the British bond market rallied as investors predicted lower government borrowing for future wars. Nathan Rothschild arrived in London just hours ahead of the news of the battle's outcome and began buying up British war bonds at bargain basement prices.Bond prices rose as yields fell and

An open letter to the American Physical Therapy Association

2009-09-21T16:45:00.002-04:00

This letter was sent to a contact at the APTA on September 21, 2009.This letter is intended to initiate a discussion and propose a course of action that is in the best interests of Medicare physical therapy beneficiaries, the American healthcare system and physical therapists everywhere.Why do Medicare auditors assess 'skilled therapy' as a criteria of payment? Because they lack an alternative

Can Evidence Based Medicine Save Physical Therapy From 'Skilled Therapy'?

2009-09-17T11:27:00.022-04:00

Can powerful new tools used by physical therapists prevent a Medicare audit?If you write in your note tests that predict the outcome of treatment could that note be exempt from a "partial denial of a therapy claim" that requires oodles of handwritten narrative "trumpeting clinicians' concerns"?Rather than trumpeting your concern in writing wouldn't you prefer to spend time thinking about how to

The 10 Most Important Words in Evidence Based Physical Therapy

2009-09-10T14:38:00.005-04:00

Bias – the systematic deviation from the truth.Atun Gawande, MD said it this way:"Three decades of neuropsychology research have shown us numerous ways in which human judgment, like memory and hearing, is prone to systematic mistakes.The mind overestimates vivid dangers, falls into ruts, and manages multiple pieces of data poorly.It is unduly swayed by desire and emotion and even the time of day.

Why TBC is not "Cookbook" medicine

2009-09-02T14:05:00.006-04:00

I got it wrong!This is first correction on Physical Therapy Diagnosis (that I'll admit to) - so don't go telling my wife or my mom!I posted three days ago that a physical therapist could use a heuristic adjustment (a 'rule-of-thumb') to published estimates of pre-test probabilities for treatment based classification (TBC) groups, for example:Stabilization = 33%Lumbar Manipulation = 45%Thoracic

Treatment Based Classification and Skilled Physical Therapy

2009-08-30T15:46:00.006-04:00

Treatment based classification slipped past me in 2003 when the American Physical Therapy Association’s Combined Section’s Meeting came to Tampa, Florida. The lead author of the original manipulation derivation study in the December 2002 Spine journal presented a talk titled “Spinal Manipulation Predictor Variables” – or something like that. I saw the words ‘Spinal Manipulation’ and that lure

Observation and Classification

2009-08-22T19:33:00.025-04:00

Kepler's First Law: Planets move in ellipses with the Sun at one focus.Kepler's First Law has applied to space scientists and astronomers since it was discovered over 430 years ago. Yet, Johannes Kepler didn't gather much of the data upon which he based his discoveries. Kepler was nearly blinded by smallpox before he was five years old.As the Imperial Mathematician to the Holy Roman Emporer,

Why Can't Connor Ride His Bike?

2009-08-17T08:32:00.012-04:00

My eight-year old son has a friend named Connor. Connor is a normal eight-year old boy except in one respect.Connor can't ride his bike.Connor is in physical therapy at school working on gross motor control, lower extremity strengthening, jumping, hopping and climbing activities. I've seen Connor run - he's a bit slow but otherwise normal. Jumping is a bit awkward but he makes it. Hopping is

Physical Therapy Insight

2009-08-11T19:05:00.005-04:00

You are confronted by the patient with intractable chronic pain – you’re the therapist – What do you do? What do you decide?Bulletproof Physical Therapy Decisions presents your decision as the ‘skilled’ component of the physical therapy encounter. And there are two types of decision you can make.Physical therapy decisions are dichotomized into two domains to draw attention to insight decisions