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PT on the Run

Outpatient PT -- A Different World

Published December 18, 2013 6:04 PM by Michael Kelley

So like all PT students, I did one of my clinical rotations at an outpatient clinic. Mine was 10 weeks in a private practice clinic down in North Carolina. My CI was great and I did learn a lot, but really, that was the extent of my outpatient experience. Even as a student, I knew the outpatient setting wasn't where I wanted to start my PT career. That being said, I thought this week I would delve into the outpatient world a little more. I contacted a friend of mine who works up in Michigan at an outpatient clinic. After an hour-long conversation about work and life, one thing is abundantly clear: I know very little about life in an outpatient PT clinic.

The first question I asked my friend was, "What's it like working in outpatient?" Her initial response included a few choice words that aren't appropriate for this blog, but it amounted to, "It's really tough." She brought up the obvious changes that came/are coming with the Affordable Care Act and how those have impacted reimbursement (it's worth noting these changes usually resulted in less reimbursement).

She talked about how her company administrators want her to make some long-term financial commitments to help provide some increased stability for the company, but upon further review, these commitments aren't looking too beneficial for her. She also brought up all the new and constantly changing rules that Medicare, Medicaid and all the various state-run or private insurance companies have and how stressful it can be to manage all of them not just on their individual merits, but collectively as well.

She actually asked me if I thought she would enjoy acute care. I told her no. I've known her since we were but lowly undergrads studying for an anatomy test in the library. Knowing her mentality and personality, acute care would not be for her. But I also explained that as far as reimbursement and changing rules goes, we aren't drastically affected like someone in her position would be. As an acute-care therapist, reimbursement doesn't play a huge role, since Medicare patients are usually in a DRG so reimbursement levels are "pre-set," and private insurance companies usually have contracts that stipulate reimbursement for acute-care costs regardless of what ancillary services are provided.

So my day-to-day productivity and units billed are more important for measuring productivity, not for determining how much money I'm bringing in. For her, though, how many units she bills and her productivity are quite literally her livelihood. What she bills helps determine the financial state of the company, and the financial state of the company helps determine her salary in a much more direct way than working in an acute setting would.

My friend talked for a while about all the "rules" that Medicare and the various other insurance agencies/companies have and how they are constantly changing. She said she was lucky since her company has a billing department that keeps up on all these changes and when something in the billing doesn't meet these rules, they contact her directly, so she doesn't have to stay on top of all the rules herself. I thought this was interesting because very rarely in acute care has my practice been impacted by a new insurance rule or something Medicare has changed. Obviously there are exceptions, but for the most part, what I've done for the past four-and-a-half years has stayed pretty much the same.

All in all, it was an eye-opening conversation. I realized that after 5-6 years since working in an outpatient setting, I've fallen quite out of practice with how an outpatient site works and how different it can be from working in acute care. This got me thinking back to when I was a PT student. As we were finishing up our schooling and prepping for graduation, I joked with some classmates that there should be an end-of-year course called "Real Life 101," where they teach you about how to live outside the confines of the university and all that. Now that I've been working in the acute setting for so long, I wonder, should there be a CE course out there called, "So You Want to Be an Outpatient PT?" Just a thought...

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