Reimbursement Issues (Full Version)

All Forums >> [RehabEdge Forum] >> Pediatrics



Message

Meredith Swittenberg -> Reimbursement Issues (July 27, 2000 1:37:00 PM)

Dear Forum,
I work in the outpatient department of a hospital which is part of a large Healthcare System as the Pediatric PT on staff. The two additional full time PTs work with 80-90& orthopedic population, which of course means their patients are doubable and sometimes tripable. Needless to say, my (as well as the other peds treaters at other sites within the system)productivity is the lowest in the dept.

As I'm sure you all are aware, managed care contracts with hospital systems reimburse a small percentage of our actual charges for our services. $50.00 reimbursement for a $130.00 charged service is the norm. Of course, that's not a problem when you can be seeing 2 patients at the same time. As we all know, peds patients are different. They are very physical and mentally challenging and require one-on-one care as well as extensive time allowed for parent education. My point is, since we are so poorly reimbursed, it appears as though peds may be too expensive for our system to continue to offer at various sites. Meaning, pediatric services may have to be centralized to one location or we just won't be able to provide the services anymore.

I have been given the challenge of forming a peds task force with all peds OT/PT in our system. The goal of our team would be to re-look at our process of treating peds and how we go about billing. Currently, the majority of our patients are scheduled for hour appointments ($130 charge, reimbursed by insurance $50) one-on-one.

My question to all of you--what are you doing to keep your dept/business afloat in this managed care world and still provide high quality effective treatment? Are you finding yourself referring kids out to the DEC (which has a 3 month waiting list for new PT patients where I live) and to school? Is there a place for outpt peds in the current insurance environment? Are you doing more groups? If so, what kind and are they reimbursable by insurance?

Drew, where do I begin researching for current information on the benefits of intensive outpt therapy for early intervention and parental education? Is there any out there? I've had a slew of poorly progressing kids lately and am beginning to doubt my effectiveness anyway. I don't want to become an orthopedic therapist providing cookbook protocol treatment, but is this where the job security lies? As my supervisor told me, We may find that it's just too expensive for us to treat peds at this site!

HELP! I'm needing some insight from all of you! Thank you very much!

Mert



Andrew M. Ball, MS, PT -> Re: Reimbursement Issues (July 27, 2000 11:46:00 PM)

Meredith,

I'm at the DEC in Durham, and I'll be going out to Charlotte in a few weeks to do a little continuing education on PWB-GT. Perhaps we can meet and go over CPT codeing issues in more detail. I'm at Andrew.Ball@ncmail.net or (919) 560-5600 x214. My director, Patsy Pierce - formerly Duncan Munn's right hand, is leaving tomorrow, so we'll be having a sobfest . . . but I'll be around early in the morning if you want to call.

Where do I begin researching for current information on the benefits of intensive outpt therapy for early intervention and parental education?
I'D START WITH MEDLINE. E-MAIL ME AND I'LL SEND YOU A LIST OF REFERENCES ABOUT WHAT WORKS AND WHAT DOES NOT WORK IN PEDIATRIC PHYSICAL THERAPY INTERVENTION THAT I'VE PUT TOGETHER FOR CONTINUING ED COURSES THAT I'VE DONE.

Is there any out there? I've had a slew of poorly progressing kids lately and am beginning to doubt my effectiveness anyway.
YOU NEED TO ATTEND THE CONTINUING EDUCATION THAT I'M GOING TO DO FOR EASTERN AHEC IN NOVEMBER AT ECU. IT'S ON EXACTLY THIS ISSUE.

I don't want to become an orthopedic therapist providing cookbook protocol treatment, but is this where the job security lies? As my supervisor told me, We may find that it's just too expensive for us to treat peds at this site!
I'VE COME UP WITH A SPECIFIC Rx TECHNIQUE THAT WHEN COMBINED WITH TRADITIONAL THERAPY, SEEMS TO BE FAR MORE EFFECTIVE, AND ABOUT 10K T0 20K LESS EXPENSIVE OVER THE COURSE OF A LIFETIME. IT DOES NOT WORK FOR ALL CLIENTS, BUT IT WORKS FOR MOST CLIENTS. SINCE YOU LIVE SO CLOSE, UPON REQUEST (AND ROOM AND BOARD - - - WHICH MOBILITY RESEARCH CORPORATION MAY COVER) I'D BE HAPPY TO COME OUT TO YOUR FACILITY AND PUT ON ANOTHER CONTINUING EDUCATION COURSE, PROVIDED WE COULD GET A LARGE GROUP OF PT/OT AND PARENTS TOGETHER ONE DAY, AND THEN RUN A CLINIC WITH A FEW KIDS THAT PT'S WANTED TO TRY THE NEXT DAY.

Drew

[This message has been edited by Andrew M. Ball, MS, PT (edited July 28, 2000).]



gerry -> Re: Reimbursement Issues (July 28, 2000 5:09:00 AM)

I understand what you are talking about. I was part of a hospital system for a few years, but we had 3 pediatric PTs. Our section was definantly not as much of a revenue producer for the system, but we covered our own expenses, and made a small profit for the system. To me, it was beneficial for the system to say they offered services for all ages, and it provided all sorts of good PR opportunities. It gave the hospital good working relationships with many other agencies (school systems, EI systems, local Easter Seals, etc.). This hopefully pays off in people coming to the hospital system for other services that might be better financially for the hospital.

We also had contracts through the hospital with school systemsearly intervention systems, and other agencies. It was a stable source of reimbursement, as compared to insurance billing, and that was appealing to my supervisor.

Good Luck in your planning!



Page: [1]



Forum Software © ASPPlayground.NET Advanced Edition 2.5.5 Unicode

0.188