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What is your average number of visits with a cuff repair.
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What is your average number of visits with a cuff repair. - July 10, 2008 1:37:37 PM
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Kaden
Posts: 329
Joined: June 17, 2007
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Hey folks,
I have been finding with these folks (depending on tear size and how range is progressing) that I can see them for 10-15 visits over a 12 - 16 week time period and then DC to HEP and they do very well.
However, I have recently been catching some grief from my director saying on should be seeing these patients more frequently as they are post op. Thought I would see what others average with this patient population before I present my case to her.
I tend to see the individual (say during the PROM stage) and if motion is coming along (and HEP going well) may reduce to once weekly or take an entire week off and let them continue at home until we can advance to the next phase of care.
The argument I get from my director is that they need to be in more often so we can monitor progress and change in status, symptoms, etc.
The end result those is she see's these cuff patients for 25-30 visits over the same time period while I seem them 10-15 and the outcomes are similar.
Any thoughts? I don't think I am approaching this wrong, but before I take a stand on this issue with my director, I wanted input from others.
Thanks
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RE: What is your average number of visits with a cuff r... - July 10, 2008 2:33:48 PM
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SJBird55
Posts: 2430
Joined: May 10, 2004
From: Michigan
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The age of the patient, the size of the tear, when the tear occurred, and the level of function desired are all factors that are important.
The older adults with large, old tears tend to take me longer in achieving results - 20-24 visits, would be my guess.
The patients that listen to the physician's recommendations immediately after surgery, have smaller tears, adhere to my suggestions and have little fear tend to have 13-15 visits.
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RE: What is your average number of visits with a cuff r... - July 10, 2008 3:53:45 PM
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TexasOrtho
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Highly variable for me as well. I put a decent amount of emphasis on the first few weeks trying to acheive good pain control and early ROM. I'd say my average for post-op cases of true repairs (not just debridements or SAD) is around 20-24. If they develop complications such as stiffness, it can get up to 30+ but that is pretty rare.
WARNING: Shameless plug of my blog to follow. I recently posted an article that indicates pain and function recover pretty similarly regardless of early pain or disability. At a six month follow up, those that did and did not fair well early in the postoperative process ended up looking about the same. The real kicker - no supervised PT for either group. Just home exericises. I'd prefer supervised PT obviously, but the point is that folks can do well clinically regardless of the volume of PT visits.
Your director has his pants in a wad because he/she probably has someone breathing down his/her neck about productivity metrics.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: What is your average number of visits with a cuff r... - July 10, 2008 6:09:45 PM
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cottonra
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We keep an outcomes (ASES) database on all of our shoulder outcomes. Our clinic caseload is approximately 40% shoulders. We see post-op RCR for 18.75 visits. (that .75 of a visit is a doozy!) This does not account for tear size, complications, etc...just one classification for all post-op RCR.
It sounds as if you and your director are being driven by different goals.
Ryan Cotton, PT, DHS, OCS
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RE: What is your average number of visits with a cuff r... - July 11, 2008 11:14:59 AM
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USAPT
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Kaden,
If you want specific numbers from PTs whose practice is 95-100% shoudlers, contact these guys at the American Shoulder Society for PTs @ http://www.asset-usa.org/.
I see my shoudler post ops 20-25 on avg for RCR (not SAD or labral tears). However, if it is a 'massive' tear I won't see them for 6 weeks or so to protect the tissue healing. And/or if they have one of the 62 consecutive day plans, you're screwed if you start them immediately post op b/c then the "skilled" time you want to see them for won't happen b/c they will have been discharged by then.
We all want the best for our pts but mgmt wants #s...inappropriate at times especially with post op care when there is minimal sklled care involved except for pt education.
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RE: What is your average number of visits with a cuff r... - July 14, 2008 3:32:21 PM
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buckeye
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kaden -- Has this topic (not enough visits) come up at your clinic in the past? Do you think the director is driven by the numbers? Or is the director just thinking the norm is to see patients three times per week?
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RE: What is your average number of visits with a cuff r... - July 15, 2008 10:09:51 AM
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Tom Reeves DPT ATC
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We do the same type of recordkeeping as Ryan and average (all rtc repairs in one big pile) 9.42 visits. That seems a bit low but I see no reason to watch someone do a home exercise program once they have demonstrated that they do it correctly.
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RE: What is your average number of visits with a cuff r... - July 15, 2008 12:00:39 PM
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Kaden
Posts: 329
Joined: June 17, 2007
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Tom,
I can't agree more about the watching folks do their HEP. It would be interesting to compare your 9.42 to others with higher visit numbers for long term functional outcomes.
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RE: What is your average number of visits with a cuff r... - July 15, 2008 1:33:36 PM
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SJBird55
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From: Michigan
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I try to have no more than a 12-15% disability on the QuickDASH.
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RE: What is your average number of visits with a cuff r... - July 18, 2008 10:50:52 AM
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VagusX
Posts: 215
Joined: March 26, 2003
From: Savannah, GA, USA
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With 95% Medicare RTC repairs are all seen 2-3X/wk for PROM X 6-8 weeks depending on the size of the tear. Phase II is 4-6 more weeks @ 2X/wk f/b Phase III which is mostly education about return to previous level of fucntion. Most are golfer's and tennis players, so lots of sport specific education. Phase III will instructed within 2-3 visits then d/c. Visit will commonly reach 30 or slightly more, but I rarely hit the 1810 cap.
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RE: What is your average number of visits with a cuff r... - July 18, 2008 11:05:34 AM
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kiwi PT
Posts: 75
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From: MI, USA (dreaming of New Zealand)
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quote:
ORIGINAL: USAPT
However, if it is a 'massive' tear I won't see them for 6 weeks or so to protect the tissue healing. And/or if they have one of the 62 consecutive day plans, you're screwed if you start them immediately post op b/c then the "skilled" time you want to see them for won't happen b/c they will have been discharged by then.
I have RCR pt that just started that has a "30 consecutive day" plan and has 12 visits authorized. Has anyone had success using reason and logic with the insurance company (Did I just use reason and insurance company in the same sentance?) to convince them that the 12 visits would better serve the pt if they were stretched out further and it wouldn't cost more to them. Or am I stuck with the 30 day? Blue Care Network is the insurance company.
Kyle PT
_____________________________
"I have never let my schooling interfere with my education."
Mark Twain
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RE: What is your average number of visits with a cuff r... - July 18, 2008 11:39:55 AM
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SJBird55
Posts: 2430
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From: Michigan
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I'm out of network for BCN. Back in the day, when I was at the hospital setting, that 30 consecutive day deal wasn't concrete. The referring physician would complete a BCN referral form. The BCN referral form could be for whatever the physician wrote. Typically, when filling out the form, the front office staff would write it for 12 visits over 30 days. So, back in the day, the authorizations were driven by that piece of paper the PCP faxed to BCN and the authorization numbers were generated from that initial referral form. (What you really want to have the referring physician's office do is call in for the authorization number - that way you don't have to wait 10-14 days for the referral to be processed for an authorization number to be provided.)
What you need to do is find out the PT benefits for that patient. The number of PT visits may not actually be capped, but may be dependent upon the completion of the physician referral form. If the visits are not capped, then a new authorization would need to be granted via the process described above.
Granted, most of the BCN contracts I have experienced were GM contracts... you're a bit east of me and apparently BCN has the old MCare contracts. MCare, I believe, did have a capped amount of visits... if BCN now has the previously held MCare contracts then the PT benefits for those employees many not be like the GM PT benefits.
If you need literature to support a greater length of time and more visits, email me. I have one nice supporting article on outcomes for shoulder problems on my memory stick and I could email it to you. (The article, not my stick!)
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RE: What is your average number of visits with a cuff r... - July 18, 2008 12:04:16 PM
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kiwi PT
Posts: 75
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From: MI, USA (dreaming of New Zealand)
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The prescribing physician's perscription and the Primary physician's "referral form" authorizing 12 visits are for more than 30 day, however pt's contract is only good for 30 consecutive days per condition, but still allows 30 visits. So technically if I saw him everyday and got another referral form from the PCP I could see him more than the 12 visits so long as I don't go past 30 days of the first visit.
_____________________________
"I have never let my schooling interfere with my education."
Mark Twain
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RE: What is your average number of visits with a cuff r... - July 18, 2008 12:09:10 PM
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kiwi PT
Posts: 75
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From: MI, USA (dreaming of New Zealand)
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I've seen lots of other versions of BCN this is the first one with a 30 days per condition, although I've seen some 60 day one. This guy is self employed so was probably looking a cut rate version.
_____________________________
"I have never let my schooling interfere with my education."
Mark Twain
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RE: What is your average number of visits with a cuff r... - July 18, 2008 12:20:54 PM
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SJBird55
Posts: 2430
Joined: May 10, 2004
From: Michigan
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Okay... then I would contact a provider representative and ask if there is any review process in place for situations in which the patient required a longer duration of time. Communicate that technically the benefit plan allows for 30 visits. Ask if there just happens to be a process that could allow for those visits to be used outside of the consecutive day clause. (The other MI BCBS policies are actually pretty strict; policies from out of state paid by BCBSM are a different story and I've had luck in getting extensions.) Also, have the patient contact member/customer services AND his employer for suggestions.
If it isn't too late - do some thinking about how this patient is going to present OR on the first visit how the patient is presenting AND think of how his presentation will change over 30 days. One way around the whole issue is in the clause "per condition." If "condition" is determined by a computer program and ICD-9 codes, well, chances are you just need to come up with a new ICD-9 code that better describes his changing "condition." As long as his "condition" is different every 30 days, you might get around the problem. That could be the loophole that allows for services to be reimbursed by BCN.
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