Chapter 1 Managing Change
- Spare Change?
- Length of Hospital Stay and Shift to Other Levels of Care
- Shortage of Professional Resources
- Cost-Containment Strategies
- Cost-Effective and Efficient Outcomes
- Shift to Prevention and Wellness
- Integrated Service Delivery
- Role Changes for the Physical Therapist
- Pro-Activity
- Who's in Control of Health Care?
- Creating New Roles: Service Delivery in the Managed Care Environment
- Physical Therapist as Evaluator
- Physical Therapist as Case Manager
- Physical Therapist as Consultant
- Physical Therapist as Educator
- Physical Therapist as Data Analyzer and Outcome Reporter
- Physical Therapist as Program Developer
- Physical Therapist as Collaborator
- ABCs of Success in Transition
- References
Chapter 2 Basics of Health Care Financing and Reimbursement
- The Four Basic Types of Health Care Financing
- Out-of -Pocket Payments
- Individual Private Insurance
- Employment-Based Private Insurance
- Government-Financed Health Care
- How Health Care Providers are Reimbursed
- Fee for Service (FFS)
- Per Visit
- Per Case or Per Episode
- Capitation
- Managed Care Players
- Physician Reimbursement
- Hospital Reimbursement
- Physical Therapy Reimbursement
- Inpatient Physical Therapy Reimbursement Issues
- Skilled Nursing Facility Reimbursement
- Outpatient Reimbursement Issues
- Managing Under Managed Care
- Creating Profit
- Coping With Managed Care
- Summary
- Health Care Financing
- Health Care Reimbursement
- References
Chapter 3 Cost-Containment Strategies
- Controlling the High Cost of Health Care
- Growing Populations and Expanding Costs
- Financing Controls
- Regulation
- Competition
- Cost Consciousness
- Competing for Low-Risk Subscribers
- Summary of Financing Controls
- Reimbursement Controls
- Price Controls
- Utilization Controls
- Mixed Controls
- Recent Research Findings
- Summary
- References
Chapter 4 Referral and Access to Physical Therapy Services
- Accessing Physical Therapy Services with Physician Referral
- Who Pays for Services After the Referral?
- Accessing Physical Therapy Services Using Direct Access
- Primary Care
- Military Model
- Who Pays for Services Using Direct Access
- Barriers in Accessing Physical Therapy Services
- Summary
- References
Chapter 5 Trends and Strategies for Physical Therapy Practice in Acute Care
- Physical Therapy and Acute Care
- Co-Morbidity
- Decreased Length of Stay
- Discharge Planning
- Prioritizing Treatment Activities
- Patient Education
- Hospital Restructuring and Patient-Focused Care
- Grouping Patients
- Decentralization
- Multi-skilled Workers
- Transdisciplinary Team
- Critical Pathways
- Charting by Exception
- Strategies
- Summary
- References
Chapter 6 Trends and Strategies for Physical Therapy Practice in Sub-Acute Care
- What is Sub-Acute Care?
- The Growth of Sub-Acute Care
- Future Growth in Sub-Acute Care
- Cost Containment as Related to Sub-Acute Care
- Quality of Care
- Acuity of Patients
- Staffing of Sub-Acute Care Facilities
- Reimbursement Issues and Recent Trends
- Prospective Payment System for Skilled Nursing Facilities
- Outcomes Evaluation
- Summary
- References
Chapter 7 Trends and Strategies for Physical Therapy Practice in Home Health Care
- Definition of Home Health Care
- Benefits of Home Health Care
- Recipients of Home Care
- Home Health Care Providers
- Hospital-Based Home Care
- Home Health Agencies
- Home Health Registries
- Hospice
- Medical Team Members Providing Home Health Care
- Physician
- Physical Therapist
- Physical Therapist Assistant
- Registered Nurse
- Home Health Aide
- Social Worker
- Occupational Therapist
- Other Professions Providing Home Health Care
- Growth Trends in Home Health Care
- Cost Effectiveness
- Employment Opportunities
- Hospital-Based Home Care
- Payers of Service and Reimbursement
- Medicare Reimbursement
- Medicaid
- Medigap
- Private Insurance and Out-of-Pocket Payment
- The Balanced Budget Act of 1997 and Changes in Home Health Care
- Documentation and Reimbursement
- Time Management and Cost Containment
- Consistent Communication
- Summary
- References
Chapter 8 Time Management Techniques
- Change Your Mindset
- I. Important, Nonurgent Activities
- II. Important, Urgent Activities
- III. Unimportant, Urgent Activities
- IV. Unimportant, Nonurgent Activities
- "If Time is Flying, Who's the Pilot?"
- Avoid the "Time Warp"
- Addressing Paperwork
- Be Aware of Miscellaneous Time Wasters
- Tools to Create Time
- Block Out!
- Block Out Time Once an Hour
- Block Out Time Once a Day
- Block Out Time Once a Week
- Why Bother? I Don't Have Time to Manage my Time!
- References
Chapter 9 Caseload Management and Delegation
- Sharpen Your Skills
- Don't Get Caught Sleeping!
- Before Patient Treatment
- During Patient Treatment
- After Patient Treatment
- Delegation
- Physical Therapy Aides May Not:
- Physical Therapy Aides May:
- Physical Therapist Assistants May Not:
- Physical Therapist Assistants May:
- Only a Physical Therapist May:
- Keys to Effective Delegation
- Communicate Effectively
- Train Support Personnel
- Empower Staff to Complete the Task
- Make Performance Matter
- Trust Your Intuition
- Know Your Patients' Needs
- Monitor Progress and Follow-Up
- Recognize and Reward Performance
- Be Sensitive to Staff Morale
- Motivate Your Staff
- Check Your Own Caseload Management Skills
- References
Chapter 10 Measuring Outcomes of Physical Therapy
- The Outcomes Movement in Physical Therapy
- History of the Outcomes Movement
- Era of Expansion
- Era of Cost Containment
- Era of Assessment and Accountability
- Organizations Active in the Outcomes Movement
- Accreditation Organizations
- Disablement Models
- Two Models of Disablement
- Outcomes Today
- Outcomes Tools
- Understanding the Basics
- Collecting Outcomes Data
- Outcomes Databases
- Commercial Providers of Outcomes Services
- Outcomes Studies
- Strategies to Prepare for Change
- Educate Yourself
- Understand Documentation
- Understand Research Design and Rudimentary Statistics
- Utilizing Technology
- Critical Indicators
- Total Quality Management
- References
Chapter 11 Documentation Requirements
- View of Documentation
- Readers of Physical Therapy Reports
- Ideal Documentation From a Payer's Perspective
- Documentation as a Legal Record
- Incident Reports
- Previous Documentation Model
- Modifying the SOAP Note
- Shift to Functional Outcome Reporting
- Documenting for Medicare
- Elements of Medicare Documentation
- Initial Evaluation
- Monthly Summary
- Discharge Summary
- Summary
- References
Chapter 12 Utilization Management
- Utilization Management
- Life Without UM or UR
- Common Questions Asked by Physical Therapists About UR
- What is the Difference Between UR and UM?
- So What Exactly is Medically Necessary and Reasonable?
- How is UR Conducted and Regulated?
- Does UR Determine Whether or Not I Get Reimbursed?
- Where Does Peer Review Fit into the Scene?
- How Are UR Criteria Developed?
- Do These Review Systems Help or Hinder Physical Therapy Service?
- Why Should Physical Therapists be Involved in Providing UR?
- How to Get to UM Before it Gets to You
- Understand UR and UM Criteria
- Familiarize Yourself with Proper Documentation
- Don't Let History Repeat Itself-Learn From Others' Mistakes
- Communicate with Members of Your Care Team
- Piecing the Puzzle Together
- Making Your Claim "Appealing"
- Exercise Your Leadership in UM
- References
Chapter 13 Quality Management in Physical Therapy
- Quality-In the Eye of the Beholder
- Quality Defined
- Quality Improvement Strategies for Physical Therapists
- Operational Definitions
- An Endless Array of Acronyms
- Steps to Quality Improvement
- Indicators
- Strategy
- Regulation of "Acceptable Levels of Quality"
- References
Chapter 14 The Role of Physical Therapy in Prevention and Wellness
- What is Prevention?
- Prevention and the Medial Model
- The Current Role of Physical Therapists in Prevention
- Prevention and the Aging Population
- Prevention and Wellness go to Work
- Backing Prevention with Back School
- Effectiveness and Costs of Prevention and Wellness
- Characteristics of a Successful Prevention Program
- Get Into the Groove
- Expand Your Horizons
- Show that You Care
- Empower with Power
- New Possibilities and Trends
- Incorporating Prevention and Wellness Into Your Practice
- Offer Your Vast Knowledge
- What's Going on Around You?
- Facilitate Worksite Wellness in Your Own Area
- Clean Up Your Own Backyard
- Summary
- References
Glossary
Appendix 1 Commonly Approved Physical Therapy Abbreviations
Appendix 2 APTA Guidelines for Physical Therapy Documentation
Appendix 3 APTA Standards of Practice
Appendix 4 Guide for Professional Conduct for the APTA
Appendix 5 Guide for Conduct of the Affiliate Member of the APTA
Appendix 6 Direction, Delegation, and Supervision of Physical Therapy Services
Appendix 7 Sample Critical (Clinical) Pathway
Index