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Toni Talks about PT Today

Old School and New School

Published April 16, 2013 1:19 PM by Toni Patt

No matter where I am, I hear the old school/new school discussion. In simplest terms, it's a comparison of how we did something years ago compared with how we do it now. In more unkind terms, it can become a condemnation of those who went to school back in the day or new graduates. It came home to me how different the thinking is last Friday.

I made a comment about how being slow in writing evaluations results in lower productivity. This was meant with a stunned silence followed by a question. Why aren't you writing them during the evaluations? That way it is billable time.

Now I admit I'm seriously old school. The people I was speaking to were new school. Back in the day, we were taught to devote our attention to the patient for the duration of the treatment session. The patient, or rather his payer source, was paying for our time and expertise. You don't take time out for prolonged documentation. You write test results. You note prior functional and living levels. You discuss goals and therapy expectations at the time of evaluation.

My understanding of new school teaching is that it's acceptable to write evaluations during the evaluation period. The same is true of progress notes etc. The reasoning is improved efficiency and less downtime. In theory, this would mean more patients can be seen in the same amount of time.

This discussion is a minefield I'd rather avoid. I simply use this as an example of the differences between the two schools of thought. I often write parts of my evaluations when I perform them. It's hard to remember details. What I don't do is complete the document. After I complete the evaluation, I begin treatment.

My new school colleagues complete the evaluation, write the evaluation and then begin treatment. I think the time is about the same. The difference is they charge for the time spent writing. For as long as I can remember, I've been told not to charge for documentation time. Things have changed. We complete the same process but in different ways.

I'm not comfortable with this new definition of what is chargeable time. Unless you discuss the evaluation item by item, I don't see it. Sooner or later I'm going to hear about my productivity. My options appear to be get with the program, document off the clock, learn to write very quickly or something completely different. I guess I'll see what happens.

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Well said, Albert! Herein lies the catch, when we change our practices to suit the bean counters, our results dimminish, then the bean counters can say our treatments are ineffective and shouldn't be paid for. It can be a very downward spiral.

I'm glad there are still practices like yours!

Dean Metz April 19, 2013 11:22 AM

I am in a single PT private practice.  I regularly see 'failed' PT patients from one of the 2 local medical clinics.  When asked what PT services have been tried before I am regularly told:  "they talked with me briefly, showed me some exercises, and used the computer".  

No hands on, which is what these specific failed PT patients needed.  They obviously treated the computer rather than the patient.  

What do you know?  The patient responded to my 'full attention', my hands on address of the muscle and joint immobility issues (that should have been addressed the first time around) and all was accomplished in an average of 5 - 9 sessions.  Exercises instructed as well.  Much more cost effective than the 1 - 2 months of 'computer treatment'.

It is obvious we are not treating the patient, we are treating the administrative demand for more 'units' of treatment.

Albert April 19, 2013 5:57 AM

Don't know if I am Old or New School, but Point of Service documentation has been around as long as I can remember. Of course since I just recently graduated in the 90s (1995), I may be new school compared to you 30 year folks. Anyway, I've tried POS documentation, but I can't stay with it, so my notes always eat up my productivity time, which does jeoporadize my job since we are required to be 85% productive. I use to have the same problem with my Home Health notes. My PT and I use to go round and around about the POS documentation, but I usually finished my notes after my last patient. I could never get my notes done before the office closed. Now we have the iPOD and its fairly easy to document on but even when you tell the patients what it's for, they still think you arent spending enough time with them versus the note writing. One of my patients actually introduced me to her family as, "This is Don, he's good, but he's the one I told you is always texting on his phone."

So, I'm trying to divide my time now, I guess between OLD and NEW school.

Don, Physical Therapy - PTA, Rehab April 18, 2013 8:14 PM
Mobile AL

I suppose efficiency needs clarification. If by documenting during an evaluation, I'm able to provide less time treating and then the patient requires additional visits, that doesn't seem very efficient to me. It may wind up being more profitable for the providing company, but an increased burden upon the patient. I wonder if that would occur if the reimbursement wasn't fee for service? What if the provider only got a flat fee for treating the condition?


Dean Metz April 16, 2013 6:50 PM

Interesting. I must be considered old school then, only 5 years out. I never do full documentation when the patient is present. I write down notes as well. But I hate it when a physician is sitting there typing away while I'm talking to them, so I've vowed never to do that to my patient's or their families. Sure it's more efficient to document as you go, but in my opinion it's rude. Our facility, at least, seems to understand, and doesn't throw a fit when productivity is low on a high eval day.

Michelle, Physical Therapist April 16, 2013 6:04 PM
Sparks NV

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