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Transition to Rehab Management

A Positive Change

Published September 14, 2012 3:20 PM by Karen Schiff

Attention this week has been focused on the Medicare cap that will be in place starting October 1. This will affect all settings of physical therapy by limiting the amount of PT that a patient can receive. As an outpatient clinician, I'm usually the last therapist to reach the patient. What this cap means to me is that I may be providing the least number of sessions, because the patient may have already had home care or skilled nursing care. This concerns me, due to the fact that at this level of care, I may be able to have a large impact on the function of the patient, now that he is in his own home or family setting.

Whie I study the systematic review of medical imaging this semester, I realize that the skills my peers and I are acquiring are preparing us for more efficient and effective skilled care. Without this additional knowledge, it may become almost impossible to request additional physical therapy services once the cap has been reached. Using the tools from the Guide and studying evidence-based care and best practices, we will be better prepared to submit required documentation once the maximum amount of therapy has been reached. This seems no different than last year (when I used what I learned to obtain additional authorization); however, soon there will be a pre-authorization required before additional visits are made.

As I talk my way through these changes, I realize the cap will, in fact, be a positive change for our patients. Undoubtedly, some are non-compliant with their home exercise programs; others become "frequent flyers." This limitation on the care we provide may work in our favor for other types of patients. We've all had the talk with patients that if they don't follow the instructions given to them, they may not show progress. The cap will work in our favor in this example.

In the next couple weeks, we will be ironing out the specifics of how to find out how much physical therapy a patient has had before he comes to our facility. This will prove to be challenging, as the resources we've been given are still not up and running. At least we can be sure that our patients will be on the same page with us since we're introducing the idea to them at the current time. During this period, we can emphasize the necessity of their compliance so they can maximize their improvement with any limitations Medicare may place on their care. We can utilize what we've studied thus far to assist our patients with a better understanding and a positive outlook.


A well thought out process...save for one thing which plagued me in a similar situation. You are assuming that the person approving additional visits will understand and appreciate the advanced knowledge you will apply to requests for additional treatments. Oft times it is a nurse who provides the review and is operating from the Milliman (or similar) guidelines. How do we convince those with lesser knowledge bases to approve needed services? One of the most frustrating things I've had to deal with when working with managed care (including managed Medicare).

Dean Metz September 17, 2012 5:36 PM

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