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WRCI stats: average number of visits
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RE: WRCI stats: average number of visits - March 18, 2008 12:29:21 PM
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SJBird55
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For BCBSM PPO claims, for a physical therapist provider to be categorized as an "A" provider, patients need to be discharged in 7 visits or less.
Utilization data alone should not be used to compare clinics. Number of visits does not provide a clinical picture of the patient's status at discharge. Neither that benchmark nor BCBSM category A tells me anything.
As clinicians we need to speak up and not allow such shallow measurements to determine the quality of care we provide.
(Edited due to my poor grammar!)
< Message edited by SJBird55 -- March 18, 2008 12:32:37 PM >
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RE: WRCI stats: average number of visits - March 18, 2008 7:51:18 PM
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jlharris
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I agree, some sort of outcome data (LEFS, ODI, etc) needs to be attached to those visits.
Example:
Lets say my average visists to D/C for LBP pt's is 6 visits with an average 40% improvement in ODI, and my neighbor PT clinic is 8 visits but a 60% improvement in ODI scores; only looking at visits would assume I'm the "better" PT.
Of course, I really don't think insurance companies care about outcomes, just how much they have to pay. With that, despite my neighbor PT getting his pt's a 60% improvement in their ODI's, insurance companies would like their clients to come to me with poorer outcomes by less visits.
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RE: WRCI stats: average number of visits - March 19, 2008 7:23:20 PM
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kiwi PT
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I did my final cinical internship at a place that was 100% WC, it was rare that we would see any non-surgical pt more than 6 visits, and many for less than that.
I agree that number of visits only isn't all that meaningful a measure.
Kyle PT
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RE: WRCI stats: average number of visits - March 20, 2008 11:58:06 PM
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ysumpt2006
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quote:
ORIGINAL: kiwi PT
I did my final cinical internship at a place that was 100% WC, it was rare that we would see any non-surgical pt more than 6 visits, and many for less than that.
I agree that number of visits only isn't all that meaningful a measure.
Kyle PT
As a student, how did you like that setting? Pros/Cons? I have an opportunity for the same type of setting.
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RE: WRCI stats: average number of visits - March 21, 2008 10:22:44 AM
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Nicole Matoushek PT MPH CSHE CEES
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I absolutely agree that visit utilization should not be used by itself to determine or rate performance. Functional outcomes such as improvement in function, even pain and return to work/life activity outcomes can be useful.
I do think we should be proactively managing our patients based on the individual needs of each patient. Guidelines are useful, but the individual patient needs to be considered. Great feedback, thank you all for participating!
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RE: WRCI stats: average number of visits - March 22, 2008 2:18:31 PM
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kiwi PT
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I loved this setting, sure there were some fakers but I get those with some auto cases now. Out of a 15 week full time rotation I'd say only two pts were completely full of sh**. I really liked hearing what people that actually work for a living do. We also did some on-site contracts so you knew what the patient actually had to do at their job. We also saw a lot of police and firefighters who were generally quite well motivated. Another thing I liked about it was the collaboration with the physicians who really wanted to know what we thought, we could walk next door and talk to them and vice versa. The drawbacks were phone call updates that we had to make to adjusters and employers.
Kyle PT
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RE: WRCI stats: average number of visits - March 24, 2008 12:33:15 PM
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JSPT
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This topic reminds me of using BMI to project a person's health status. I think the way I remeber it is that BMI is a good way to sort data related to very large numbers of people (many thousands), but is not useful when it comes to an individual.
I agree that looking at visit totals is really dangerous.
SJ, the thing that gets me about the BCBS stratification is system is that it may end up really hurting private practices. So this year your clinic numbers need to be under 125% to be an A or B level provider; what happens when many clinics in Michigan cut their visit numbers by 10-20%? Does the bar get lowered further? When does it end?
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RE: WRCI stats: average number of visits - March 24, 2008 2:26:34 PM
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Tom Reeves DPT ATC
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Personally, i think that something like this has to be done. I agree that putting a bright line at a certain number of visits is definitely NOT a good idea but how are people supposed to be able to shop for their health care? We need an outcome based advertisement system.
If you want Mercedes and will pay for it, you go here.
If you want Chevy Cavalier - you go there.
Right now it is basically word of mouth. We all know that almost every patient is convinced that their doc is the best. Right now, we just politely nod our head. What if there were a menu that was available to everyone. Por ejemplo: treatment of non radicular LBP at PTX clinic costs on average $396 and has an average improvement on the Oswestry disability scale of 8 points. At PTY clinic, a course of PT for the same diagnosis costs an average of $550 with an improvement of 13 points on the Oswestry.
Let the people make the decision. The problem is many don't want to participate in their care at all, they want a pill, or a manipulation, or an ultrasound, or two weeks off work etc . . .
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RE: WRCI stats: average number of visits - March 25, 2008 10:14:09 AM
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JSPT
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I hear your point, Tom, but disagree with how to get there. I know you were just using Oswestry scores and number of visits as an example, but I think that is exactly the kind of figures many clinics will abuse.
It's too easy to fudge numbers and then advertise them. I see huge potential for abuse by clinics, which would necessitate some kind of regulatory body for oversight. I think we need to have some sort of quality measure, but it is going to be a long, hard road to get there.
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RE: WRCI stats: average number of visits - March 25, 2008 2:00:20 PM
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Tom Reeves DPT ATC
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You are right. I don't see any way to ensure that people (read providers) won't cheat. If there were, there would be no need for oversight, visit approval, medicare fraud investigators etc . . .
If insurance providers would be more forthcoming with cost savings of PT vs other providers for NMSK diagnoses we would have that battle won. Unfortunately, the AMA (along with some other groups)won't allow that to happen. We do a pretty good job of policing ourselves but there are fringe groups out there.
What would be your recommendation on "how to get there?"
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RE: WRCI stats: average number of visits - March 25, 2008 2:31:47 PM
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jlharris
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What kind of "regulatory body" oversees outcome data from the ortho's that refer to you, me, us? Should we assume the majority cheat? I'm sure there would be some that "fudge" numbers, but what kind of system do we have where we assume cheating unless proven otherwise?
IMO, we need to get PT's to collect outcome data now, and don't delay or make excuses for not doing so by assuming others will cheat. Be accountable to yourself and your patients first. Worry about the few that would cheat later.
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RE: WRCI stats: average number of visits - March 25, 2008 2:56:54 PM
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Tom Reeves DPT ATC
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that is my point of view also Jason. I guess my last post appeared otherwise. i was being a bit sarcastic. We need to assume that the majority of providers are honest and have the best interest of the patient in mind. What I was saying earlier is that there will always be cheaters. We can't let the cheaters dictate what the rest of us do. Gather data, correlate with cost make it available for everyone to review and let the public decide where they go.
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RE: WRCI stats: average number of visits - March 26, 2008 6:33:58 AM
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JSPT
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I think the first step would be setting a gold standard for outcomes. The Oswestry is one of the best measures for improvement in LBP, but still has some shortcomings. Once our profession has the best outcome measures in place for, say, our top 10 diagnoses, providers should start utilizing them and collecting data.
I just think that to starting to collect now would be putting the cart before the horse, and would invite a flood of problems.
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RE: WRCI stats: average number of visits - March 26, 2008 7:52:38 AM
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Tom Reeves DPT ATC
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That would be a good plan.
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RE: WRCI stats: average number of visits - March 26, 2008 9:58:08 AM
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SJBird55
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JSPT, when LandMark and BCBSM did their "presentation" in the Lansing area, hardly any PT's spoke up about their "system" of monitoring therapists. They got an earful from me... AND the LandMark people couldn't respond to specific questions with regard to "quality." I voiced that a "how low can you go" kind of game is unreasonable because that is exactly how this new "venture" is going to lead.
JSPT, WE should be the ones gaining our own information, definitely. You have to remember, payors will only be using claim data and THAT is where the problem lies - the claim doesn't include relevant pieces of information to judge anything. There isn't any easy answer either - one can't have outcome data on every single claim. Think about it... the data could be on the claim with a 97001 code, yes.... but if electronic claims are sent out daily, it is unreasonable to have fresh outcome data on every claim. Then... it could be included at discharge on the discharge claim, but even that would be difficult depending on the system in place between clinicians and billers. At the same time, think of the frequency that a discharge occurs and you didn't plan on the patient being discharged... data will be missing in those cases.
Another aspect that is relevant, as Tom mentioned, cheaters. With any reporting system in place, it would be very, very important to know the rate of completing the outcome tools. Meaning, what percentage of patients have full, complete information (initial data and discharge data). An 80% or higher completion rate would probably be really, really good and indicative of data collected from most patients. Most research tends to have a 50-60% completion rate which is really, really poor and could mean cherry-picking.
All I know is that BCBSM and LandMark are making a mistake. Also, JSPT, do you realize that the number of visits for physical therapists practicing in a private practice are different than for physical therapists in a hospital setting? Claims that are generated on a UB92 are allowed a few extra visits. PT is PT, so THAT pissed me off too. Why do those in private practice need to have less visits than those who practice in a hospital setting? Hmmm... AND I have no idea what kind of requirements are met for physician owned. They couldn't answer that one for me.
And our fabulous MPTA hasn't said a word about this BCBSM PPO crap... SO glad I'm a member of a proactive organization...
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RE: WRCI stats: average number of visits - March 26, 2008 12:38:37 PM
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JSPT
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I hear you, SJ. I asked our clinic owners about banning together against BCBS, but it comes down to "who has the deepest pockets" when a fight like that is started.
Yes, I was aware of the hospitals getting more than us. You're probably also aware that we, as a "rural" clinic, also get re-imbursed less than a metropolitan clinic. Therefore, we have less volume and get paid less per visit. Yep, the system is broken. Because about 40% of our patients are BCBS, any changes they make hit us hard. I see that they just cut our rates again last year.
*Sigh*
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RE: WRCI stats: average number of visits - March 26, 2008 2:35:55 PM
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SJBird55
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I had a discussion with a delegate... I want to know who or how it is determined that rates keep getting cut and cut and cut? I suggested that she speak to the Attorney General since he's got his panties wound up over BCBSM and their 2 new bills that passed through the House. Apparently BCBSM wants to control premiums. The MI AG put together a major power point on BCBSM. It was sickening! http://www.michigan.gov/documents/ag/Blue_Cross_11.29.07_217273_7.pdf Take a look at it! So... BCBSM wants to control the premiums... wants to continue to be a non-profit AND continues to reduce payments to providers. BCBSM wins every time... Why we can't stand up and join with other providers who are sick and tired of the cuts beats me. It just can't be legal for BCBSM to have the amount of control that they do. My costs and the cost of living rises and reimbursement decreases. Go figure... Everything seems to be regulated, you'd think BCBSM and third party payors would have to have some sort of regulation to ensure they are paying correctly.
The hospital situation on reimbursement was supposed to change this year. With the PPO schedule, for anyone who participates, BCBSM is robbing Peter (us) to pay Paul (Landmark)! The PPO fee schedule is substantially less than the traditional schedule and I don't even know if a "traditional" plan is offered any longer.
Are you headed to the spring Membership meeting this Saturday?
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RE: WRCI stats: average number of visits - March 27, 2008 8:25:03 AM
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Tom Reeves DPT ATC
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You would think that the payors would find it in their best interest to satisfy their clients by finding the best practicioners and recommending them to their clients. I work in a rural hospital setting so I get more leeway, but my PT teeth so to speak were cut in a privately owned PT clinic in a suburban/metro setting so that is more how I practice.
IN GENERAL, private practice generates better outcomes because you don't have built in referral base. You piss off your doctors, or word gets out that you are "gouging" people by keeping them on your schedule for too long and you are sunk.
Payors should recognize that those PTs who get their patients better faster, deserve a bigger paycheck, i.e. reward excellence. Unfortunately, the socialist bureaucratic claptrap that is our healthcare system is so devoid of market influences that it can't fix itself because it is being run by accountants.
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