By Susan Rigby and Cary Edgar
Ancillary Care Solutions

Whether you are thinking about starting a physical therapy program or

already have one, you need to understand the quality and financial indicators that should be used to measure success.  Too often success is only measured by the number of patients scheduled or the dollar amount billed, but this is only part of the picture.  Success should be measured using the following guidelines:

• Satisfaction – Are patients and physicians satisfied with the services provided?  Are you measuring satisfaction by using a survey or interview technique?   It is often better to let patients know that surveys will be collected by an unbiased party so that patients will feel more comfortable being honest with their responses.  Also, are the physicians receiving feedback regarding therapy from their patients?  If not, we suggest that physicians informally ask their patients how therapy is progressing.

• Outcomes – Were goals set by the therapist and patients and were they achieved?  How many patients met goals at discharge and how many quit attending therapy before reaching their goals?  If 50% or more of your patients do not meet goals, this should be addressed.  The most common reason that patients discontinue therapy is that their therapists have not taken the time to explain what they are trying to accomplish and the importance of therapy.

• Appropriate billing – Are therapists appropriately billing their services?  Are they following the Medicare “8 minute rule” for billing therapy?  Medicare billing requires therapists to total the number of minutes that skilled therapy was provided to the patient and to divide that time by 15 minutes.  If 7 minutes or less is left, that time is not billable.  If 8 minutes or more is left, then an extra unit can be billed.  Other insurances may not follow the 8 minute rule.  For example, if a patient receives 10 minutes of therapeutic exercises, 10 minutes of manual therapy, and 10 minutes of therapeutic activity, Medicare will only allow 2 units billed because there are only 30 total minutes of skilled therapy provided.  A non-Medicare insurer would allow 3 units to be billed.  In addition, does the documentation support the skilled treatment provided?  Billing alone does not indicate success unless there is documentation to support what is billed.

• Scheduling Patients – Are new evaluations scheduled within 72 hours of receiving a referral?  If not this needs to be the goal.  The longer a patient has to wait to begin therapy, the more chance there is of them cancelling.

• Referring patients to therapy – Does the person who initially talks to the patient about therapy convey the importance and necessity of therapy to their recovery or does that person tell the patient to “try it” and see if it works.  The initial approach often makes the difference in whether a patient regularly attends therapy or not.

• Setting Functional Goals – Does the therapist involve the patient in setting the goals for therapy?  If the patient is part of the goal setting and the on-going communication of progress toward those goals, they are more likely to continue therapy.

• Listening to patient concerns – Does the therapist really listen to patient concerns during the therapy session?  If the patient complains of more pain, that is a “red flag” that they are concerned that therapy is not working.  If the therapist explains the reasons for short-term increased pain, it helps the patient work through the problem and continue therapy.  Patients sometimes are subtle when discussing their concern over the cost of therapy.  If this is a problem, there should be an option for developing a budget plan to extend payment over a longer period.  With higher co-pays, it is sometimes difficult for patients to choose therapy over the cost.

• Appropriate staffing – Many clinics do not look at their staffing models.  Most clinics do not need to hire all physical therapists.  Physical therapist assistants work in the same way as physician assistants.  They can see patients and bill the same as a physical therapist.  The only task they cannot do is evaluate the patient.  They also need to follow the supervision rules of their state practice act.  Physical therapy aides are patient extenders that can help the therapists to better handle their caseload.  The aides are trained on the job and can often help leverage the therapists’ time. 

• Reviewing EOBs – The amount that therapists bill for their services is only part of the picture of a successful practice.  The amount you get paid is the other part.  Often clinics leave money on the table because they do not appeal denied services.  It is also important to know the rules of the various insurance companies so therapists know how to bill and what codes are accepted.  For example, Medicare considers the application of hot and cold packs as a “bundled service” and does not pay for them separately.  Worker’s compensation, on the other hand, usually pays for this code.   Money could be lost by not billing 97010 to the appropriate insurance companies.

• Tracking number of visits – The average number of visits per patient is 9-10.  This varies based on diagnosis and medical complications.  But if a patient is seen for 15 visits or more with little progress toward their goals, this should be discussed with the physician.  Should the treatment plan be revised or are there other issues involved that might require a visit to the physician?  The longer therapy continues without significant progress, the less the patient is willing to continue treatment.  It is important that these issues be discussed with the patient so that they know that other approaches may be needed.

A successful practice has a low no show and cancelation rate, good communication between the patient and the therapist and documented steady progress toward the patient’s long-term goals.  Billing and coding are appropriate and if there are problems they are addressed and communicated to the team.