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are we overtreating
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are we overtreating - August 9, 2007 5:49:37 AM
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laptma
Posts: 20
Joined: August 9, 2007
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hi all,
warning, vent coming!
The company that I work for (Outpatient) recently had a meeting where we discussed productivity and the like. Nothing new there, but I've been noticing what I think is a disturbing trend, and from this I ask, are we overtreating?
Company wide expectations for productivity are, among other things, that our average units billed be 3.5-4.5 and that our average visits per patient increase to 9.5. There are other expectations as well, as in any other business, but these bother me the most because in order to meet them they lend themselves to overtreating. According to the company, this is the trend all over the country!
I've heard in-patient therapists say the same type of thing "we're slow so lets keep on people longer”, or “bump them up in category”, etc.
Are we changing our treatment plan in exchange for interventions that would allow for double booking? Are we forgoing “hands on” treatments to meet productivity goals?
Do we truly have our pts best interest in mind?
I thought part of our goal is to keep health costs down, i.e. get people better in a shortest amount of time possible! This seems to go against that.
Our professional organization keeps going forward with wanting to get us autonomy, but we don't seem to be able to get that with in our own practice setting! In order to meet those goals, PT's often have to have a tech "walk through an exercise program". Is this really skilled if a PT/PTA does not have to be the one doing it? Was that not originally the purpose of the PTA to do these things.
Frequently I hear DC's get killed on this site for "seeing people forever". Is this not the same premise, seeing pts that don't need to be seen!
MD's that I know may be expected to see a certain amount of pt's per day, but I don't know any MD's that are told to see pt's more often, or perform more expensive procedures. They may do so, being more thorough out of fear of litigation, but not to pad the bill.
We all have productivity goals, but when you get to "how often" or "how long", shouldn't that be up to the individual therapist? Isn’t it why we went 6-7years to school for?
I'm sure there are those here who'll say "suck it up", and that’s fine, but I am really curious to see what others feel about this.
Does this bother anyone else?
I'm not talking just about the legality, but also the ethics of it.
Is this even an ethical issue, or should I "just get over it"?
Really interested to see what others think.
Thanks for the input.
< Message edited by laptma -- August 9, 2007 7:27:49 AM >
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RE: are we overtreating? - August 9, 2007 6:13:08 AM
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ginger
Posts: 658
Joined: February 26, 2005
From: Melbourne Victoria
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very pleased to read you have a moral code, an ethical principal and a whistle to blow. take a deep breath.
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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RE: are we overtreating? - August 9, 2007 6:53:37 AM
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Sebastian Asselbergs
Posts: 1191
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From: Barrie, Canada
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Yep - it is ethics AND it is established in most Codes of Ethics and Standards of Practice or practice laws or whatever. Don't get over it. Look for another employer. Your enjoyment in the profession requires a workplace you can grow in - not one that feels like you are cheating....
_____________________________
Mundi vult decipi
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RE: are we overtreating? - August 9, 2007 6:58:36 AM
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SJBird55
Posts: 2429
Joined: May 10, 2004
From: Michigan
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The blog at evidence in motion has some of the same points you bring up. Topic has to do with Referral for Profit, but pretty much the whole theme of what you are stating here is brought up there too.
From a futuristic point of view, the system in which you are employed is not setting itself up for any potential positive return from third party payors. My utilization has been tracked by an outside source contracted by BCBSM for the last 2 years.
I also bet you the way most of your colleagues meet their productivity is to pawn patients off onto technicians to capture the extra unit or two... hmmm... issues.
It is just so stupid how things are, really. As reimbursement decreases, management comes up with new "games" to increase revenue. I don't understand why we as a group can't just really bond together, regardless of employment situation and work to improve reimbursement versus setting the unwritten rules/expectations to play the system.
You have every right to feel as you do. AND... out of curiosity, how many other therapists in the organizaton feel as you? Can all of you come together and fight for your autonomy?
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RE: are we overtreating? - August 9, 2007 7:31:51 AM
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laptma
Posts: 20
Joined: August 9, 2007
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SBJ, we were an hospital that got outsorces to a huge for profit. Rehabcare to be precise. All the PT's I work with applied, and were hired at the hospital prior to this. The length of working at the same site is from 3 years to 27.
We all took a pay cut because we believed in the mission.The mission changed once the new company came in. To put my money wher my mouth was, I took approximately a 20% cut because I believed in it.
Sort of idealistic , but it hasn't seemed to work out so far!
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RE: are we overtreating - August 9, 2007 7:41:22 AM
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laptma
Posts: 20
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Do we have any legal recourse if we were terminated bc of these issues?
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RE: are we overtreating - August 9, 2007 9:06:01 AM
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Shill
Posts: 1090
Joined: February 13, 2003
From: Madison WI USA
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One can not "bump up" an "average number of visits" without being somewhat unethical. Either they need it or they dont, so purposely "bumping it up", would mean that they did NOT need it. Ethics violations are serious, whether legal or illegal, and that may be recourse enough. News of suspected or accusations of unethical practices are not the kind of press a clinic wants.
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RE: are we overtreating - August 9, 2007 11:09:47 AM
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orthotherapist
Posts: 217
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It is not just specific to therapy. MDs are required to see a certain number of patients per day but if they are in an organization they are often reimbursed based on their RVUs (incentive to overtreat). I knew of one physician that would do bilateral TKA's but would space them apart a couple days. If he did both on the same day he would get less $$ than if he did them different days.
Anyway I was in a similar situation in the past and exited stage left at the first chance I had because I could not accept what they were telling us we had to do.
How do they treat medicare? How much time are you alloted to see them? etc etc. In my eyes this would be the most pressing issue as 3.5 to 4.5 units per patient on average would be hard to accomplish legally if you treat medicare patients unless you only have one patient scheduled per hour.
If there were suddenly a capitated payment arrangment between the insurance companies and your facility I guarantee your employer would want you to d/c ASAP and only see for 1-2 units - funny how $$ has the potential to change things
Not a good situation - look at your options.
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RE: are we overtreating - August 9, 2007 7:21:16 PM
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ginger
Posts: 658
Joined: February 26, 2005
From: Melbourne Victoria
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laptma, after reading the further comments of those above in response to your dilemma , I am more than a little warmed to my cold lonely old heart. There is a difference between right and wrong. We are all , we would hope , capable of telling the difference, it is what we are prepared to do about it that is the key.
You will always have an incling when you are pushed to go beyond your ehical boundaries. I feel sure you are guided by them. Being honest is not the only way to live , just what we can choose if we want to keep on liking ourselves.
You have my support.
Cheers
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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RE: are we overtreating - August 12, 2007 9:15:15 PM
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SJBird55
Posts: 2429
Joined: May 10, 2004
From: Michigan
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lap... let me assist you.... the site I was suggesting is not within this forum. Check this particular blog thing out... it's definitely long, but some of your concerns are brought up by other physical therapists. http://blog.myphysicaltherapyspace.com/2007/07/rfp---get-the-p.html
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RE: are we overtreating - August 13, 2007 9:08:27 PM
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laptma
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thanks!
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RE: are we overtreating - August 14, 2007 12:52:48 PM
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USAPT
Posts: 278
Joined: January 14, 2004
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laptma,
The reasons you stated, amongst others, is why I left my ortho managerial position and opted for a break with traveling. Last week I visited my old clinic and a colleague read me an email for the VP which had to do with 'recapturing of visits' in the same week...the title of the email was "Lay Down the Law" to your patients. Are you kidding me, what are we police now?
Bottom line is, as stated above, find yourself a better company that fits your standards. They're are ethical PT businesses. So if you have to move to find one, maybe it's a blessing in disguise. Good luck!
-Jason
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RE: are we overtreating - August 14, 2007 2:23:56 PM
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Rwantz
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Joined: December 10, 2004
From: Middletown, PA
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I think that this is a bad thing for business and for a profession. Why would you want to not get your patients better even faster? The doctor will appreciate it and so will the patient. Now that does not mean that you don't give everything you can to your patient.
I see therapists all the time treating beyond when a patient should be treated. They are wrong in doing so. This is costing the patient, and the insurance company money.
I know that employers want more units billed and that cash is the goal, but if a patient does not need 4 units of exercise or 1 unit of modality (my list continues forever as I see unnecessary treatments performed regularly). Why is this done? It is not for the benefit of the patient to sit on electric stim if they have no pain and disconfort.
Bill for what you do, but don't do what doesn't need to be done. Do for your patient what you feel they need, and you are educated enough to know when they do not need something. I think it is sometimes harder to figure out when they need something that is not being done. Let's not do what everyone else is doing and do what is right. That has to be respected.
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RE: are we overtreating - August 15, 2007 8:17:40 PM
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laptma
Posts: 20
Joined: August 9, 2007
Status: offline
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thanks guys, I appreciate the feedback.
I just felt I was the only one this was bothering! It amazes me how many of us just go along with the company line. I don't see how this is good for our profession.
I'm glad that there are others who feel the same.
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RE: are we overtreating - August 15, 2007 8:19:27 PM
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laptma
Posts: 20
Joined: August 9, 2007
Status: offline
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that's exactly what I'm doing, weather they like it or not. If they wanna discipline me for not overtreating, so be it!
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