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62 Cards in this Set
- Front
- Back
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*Final Elements of Patient Management
(What the PT does from start to finish with a pt:) |
-Initial eval (includes detailed discussion of pt's past history) -Diagnosis-different from MD; function based -Prognosis-PT's educated guess about what interventions will work, and if they will work long term -Plan of Care- -Intervention-should be performed under supervision of PT -Re-examination-following eval to see if pt has met goals - official documented meeting **not to be confused with reassessment which should constantly be done** -Discharge/discontinuation-no longer in need of services Communication/coordination/documentation-honesty to pt about prognosis |
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*Final Interview Questions that can't be asked |
-Interview
Race, religion, pregnancy, age, marital status
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*Final Job Specifications-subjects areas |
Degree from accredited program Pass ceritfication physical requirements |
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*Final Staff Motivation
(What are some things the PT can do to motivate staff to be the best they can be?) |
1. Challenge employees for self-improvement 2. Good working conditions 3. Recognition of performance 4. Relaxed and friendly environment 5. Enhanced/extra opportunities 6. Show genuine concern 7. Acknowledgment of contributions 8. Fair compensation 9. Consultation regarding problems 10. Realistic job expectations |
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*Final Continuing Education |
Requirements - 20 hours every 2 years
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*Final Incident/occurrence and sentinel event reporting |
1. Incident/occurrence report - should be filled out each time (ex: pt slips and falls on the way to clinic - must fill out detailed document on what happened)
2. Sentinel event - longer, creates policy changes or analysis of procedures - determines what needs to be done in a certain event - get someone higher than organization involved |
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*Final Health Care Marketing
(includes what?) |
1. Assess needs of public and ability to meet needs 2. Marketing methods: brochures, billboards, word of mouth, newspapers, etc. |
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Service Management
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1. Successful Management -Positive attitude, supports open communication and team building, proactive response to changes in the market and healthcare
2. Program Development -To meet the needs of employees or specific patient groups -Improve visibility of the facility -Take an idea and make it a reality |
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4 steps of program development |
-Needs assessment - purpose of designing program, demographic, wanting to meet
-Program planning
-Program implementation - document the program
-Program evaluation
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What is a budget? |
**Income & expenditures**
1. Personnel 2. Buildings/physical space 3. Equipment 4. Supplies 5. Other expenses |
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*Final Expense budget |
- Operating expense budget - daily cost of clinic -Capital budgets - rent, building, mortgage, tables, computers, equipment, etc.
Where is the income coming from? Insurance and patient responsibility |
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*Final Cost types of PT clinic: |
-Direct: necessary for operations, salaries, equipment
-Indirect: utilities, laundry, marketing expenses
-Fixed: rent, mortgage, utilities, malpractice, insurance
-Variable: changes with volume of clinic, labor force needed (equipment, maintenance, laundry, all dependent upon volume)
-Discretionary: not essential for surface (con-ed courses pd for employees) |
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*Final Types of Accounts: |
Payable - need to pay out
Receivable - incoming moneys |
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*Final Quality Assurance and Improvement |
-Quality Assurance: making sure to provide the type of service that was promised. Great way to improve self and clinic (can improve cost effectiveness; pt surveys; making sure pt met goals)
-Continuous Quality Improvement: systematic and ongoing approach to looking at service providing past and future (always trying to be better) |
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Quality is Different for Different Parties
(Name the three parties and how they differ) |
-For providers: freedom to practice the current state of the profession, have autonomy, and provide the pt with optimal care
-For consumers: when provider's recognize their needs, are courteous, and communicate concern, and when the consumer's health improves with the care provided
-For third party payers: when there is efficient, effective use of funds, client satisfaction, and the client returns to their prior work or functional level |
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Utilization Management: |
-Monitoring provider performance in comparison to a standard or expectation -Holds practitioners accountable to necessary and quality treatment -Can improve quality of care by detering unnecessary or inappropriate treatment (gives best quality care in least amount of time, chart audits, pt satisfaction surveys) -Saves money by imposing cost-containment strategies |
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Utilization Management vs. Utilization Review |
Review: retrospective - after the fact and cannot do anything about it by that time
Management: prospective - can prevent inappropriate care from continuing, attempts to direct care, involves case management |
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Advantages and Disadvantages of Utilization Management and Review: |
Advantages: can lead to: better treatments, improved reimbursements, give peers new ideas, may have to show pt needs therapy
Disadvantages: extra paperwork, some therapists feel like they are being stifled |
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Quality Improvement Strategies:
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-Make the pt and family a partner (sometimes family gets in the way) -Treat the whole pt -Hold yourself accountable to those areas where your facility is falling short of quality -Make your own contribution as an employee |
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Steps to Improve Quality: |
1. Identification of potential problems (indicators) 2. Objective assessment of possible causes 3. Implementation of decisions or actions designed to eliminate identified problems (strategies) 4. Monitoring activities to ensure desired results have been obtained 5. Documentation to substantiate that quality has led to improved pt care |
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Levels of Care: |
Primary: basic medical needs - general practice; ex: family doctor, pediatrician, OBGYN Secondary: Cardiologists, PT, OT, etc Tertiary: neonatologist, radiation oncologist; very specialized Acute: hospitalized less than 7 days Sub-Acute: no longer considered "critical" but can't participate in long term therapy Transitional: long term care; medically fragile people that can't take long segments of exercise Ambulatory: outpatient care
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*Final Institutional types: |
-Skilled nursing facility (can stand within hospital) -Inpatient rehabilitation: short term -Long term care facility -Custodial care facility: ADLS -Hospice care: pt within 6 months of death -Home health care: transitions into rehab setting -School system -Private practice |
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*Final Skilled Nursing Facilities: |
-Multidisciplinary: RN, PT, MD -Medicare Part A: full coverage first 20 days -Medicare requirements: must be hospitalized for at least 3 days beforehand -Based on Resource Utilization Groups (RUGs): rehab is most often used, Medicare will cover SNF if the patient falls into this category, connected to the number of minutes of therapy the patient will receive and the reimbursement for services -Group therapy: providing the same therapy tasks for 2 different individuals Concurrent therapy: 2 different tasks provided to 2 different individuals |
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Problems with Skilled Nursing Facilities: |
-Required to have 1 RN during the day shift and licensed or unlicensed nurses 24 hours
-Frequent rehospitalization due to financial incentives, concerns about liability, lack of advanced care planning, and insufficient staff |
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*Final Inpatient Rehab |
-For patients needing intense rehab 3-4 hours of therapy per day 5 days a week 20-28 days
-Required services: Physician monitoring and provision of care, rehabilitative nursing, therapies (PT, OT, ST), psychosocial/socialwork intervention, orthotic and prosthetic services
-Patients are put into Rehab Impairment Categories (RICs) and further into Case-Mix Groups (CMGs)
-FIM: Functional Independence Measure
-The 60% rule
-Interdisciplinary team meetings
-Patient expected to make reasonable progress (discontinue if not)
-Group therapy- more allowed by medicare in this setting |
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What is the 60% rule? |
60% of current case load must have 1 of 13 selected conditions. These consist of: stroke, spinal cord injury, mental disability, amputation, multiple major trauma, him fracture, brain injury, neurological disorders, burns, 3 arthritic conditions that aren't getting better, both knees or hips done at same time. |
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*Final Outpatient Therapy: |
-Fee for service/per visit -ICD-9 codes used for diagnosing (changing to ICD-10) -CPT codes used for billing-payment based on necessary skill used to perform task -Service based codes -Time based codes-change with unit -Therapy caps-Medicare cap PQRS |
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*Final US Health Care System: |
-Traditionally health has been defined using a medical model -Assumes that illness and disease require treatment -Health care focuses on the diagnosis and treatment -Recent shift of interest from illness to wellness -Wellness model focuses on the prevention of disease and the maintenance of well-being |
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*Final Deomographic trends: |
-Americans are living longer -77.9 years from birth -Upon reaching 65, men live to 82 and women to 85 -Impact of baby boomers -Record number of babies were born between 1946 and 1964 -Between 2010 and 2030, 76 million baby boomers will reach 65 |
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Impact of aging population: (Boomeritis) |
-Increased demand for home health and geriatric care -As longevity increases, interest in quality of life increases -Preventative health care becomes important -Increase: well visits, diagnostic screening -People more aware of importance of exercise, diet, alternative treatments |
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Gender Impact: |
-Women need reproductive health care -More often single head of household -More often live in poverty -Live longer than men -Require more access to healthcare over their lifetime |
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Health Outcomes: |
-In the last 30 years morbidity & mortality of disease has steadily declined by almost 50% -Healthier lifestyles -Vaccines - childhood throughout lifespan |
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*Final Patient Protection and Affordable Care Act: |
-President Obama signed into law March 2010 -Intends to improve health care in 3 ways: 1. expand access to care by increasing access to insurance (individuals are required to have coverage, employers are required to provide coverage, benefits under public programs are expanded) 2. Provisions to control health care costs 3. Seeks to improve health care delivery system's performance and quality through specific mandates |
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*Final Changes in Health Care |
-Decreased length of stay of inpatients in hospital, more services being delivered in sub-acute care, outpatient, and home health settings (women usually go home the same day of giving birth...to keep costs down) -Shortage of PTs and PTAs -Cost containment strategies (how to keep costs down) -Increases emphasis on functional outcomes -Shift to prevention and wellness -Integrated service and delivery (Interdisciplinary case management - ex: PT, OT, ST)
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*Final Role of PT/PTA Team: |
How has it changed as a result of previous changes? -more jobs out of the hospital -larger ratios of PTAs to PTs (more independence now than 10 years ago) -Documentation focusing on functional gains |
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Insurance Terms: |
-Benefits: amount of coverage -Premium: cost of that coverage -Insurance policy: legally binding contract -Deductible: amount the patient must pay before the 3rd party (insurance co) will pay - higher the deductible, lower the cost of policy -Copayment: patient pays for a portion and the insurance pays for a portion |
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*Final Four Basic Types of Health Care Financing: |
-Out of pocket payments: no insurance; the pt pays cash
-Individual private insurance: purchased own insurance
-Employment-based private insurance: first level paid for by employer
-Government financing: Medicare/Medicaid |
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Medicare:
(Medicare in the beginning:) |
-Social Security Act of 1965 -established Medicare and Medicaid -provides insurance coverage for elderly & poor
-1972 Medicare benefits extended to individuals with: -disabilities and permanent kidney failure
-Services coordinated by: -Health Care Financing Adminiatration (HCFA) from 1977 to 2001 -Centers for Medicare and Medicaid Services (CMS) 2001 to present
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Medicare (Today): |
Today provides benefits to:
-people 65 years of age and older who are receiving or eligible for Social Security Retirement benefits -younger individuals with disabilities who meet the Social Security Act's requirements for disability and have received SS benefits for at least 24 months -individuals with end-stage renal disease (ESRD) |
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*Final Medicare Parts: |
Part A: -Inpatient or "hospital insurance" - covers first 20 days in hospital -financed through SS taxes from employers and employees -hospital stay, SNF, hospice, most home health **Automatically enrolled after 65 - must pay and enroll!**$104.97 per month; $147 annual deductible
Part B: -Outpatient or physician services -financed through federal taxes and monthly premiums from subscribers -PT, x-rays, immunizations, ambulance transportation, DME -Optional
Part C: (Humana) -Medicare advantage plans -provided by private insurance companies -may have an extra monthly premium -different plans have different out of pocket costs -must at least cover everything that original Medicare does except for hospice (Part A covers hospice)
Part D: -drug plan -"donut hole" - pays for percentage of drugs ((will go away in 2020)) -Optional |
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How are health care providers reimbursed? |
-Retrospective payment system: rate of reimbursement is negotiated after the services are delivered (primary means prior to 1980) -Prospective payment system (PPS): reimbursement rate is negotiated prior to services being rendered |
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*Final 4 Basic Reimbursement Methods: |
1. Fee for service (FFS) - pay as services are rendered 2. Per visit - blanket price no matter what is done 3. Per case or per episode - by category: RUGs pay certain amount of money for certain groups under RUGs 4. Capitation - one payment per month per member regardless of services rendered |
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Managed Care Players: |
-Fee for service with utilization review:
-PPOs (preferred provider organization, pay more for out of network than in network) -An arrangement in which a specific group of providers agree to provide services for their subscribers at a negotiated FFS rate, which is usually less than their normal rate
-HMOs: -combine insurers and providers into one entity -prepaid group practice (prospective payment)
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*Final Reasons payment might be denied to Provider: |
-If no payment in partial, the provider may or may not be able to bill the patient for the difference -Reasons for payment denial: 1. error in filling out claim form 2. incomplete documentation 3. uncovered benefits 4. termination of coverage 5. failure to obtain preauthorizatons (scans and surgeries must be preauthorized) 6. out of network provider - sometimes will not pay at all |
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*Final What about those who are uninsured? |
-Less healthy than those with insurance -Twice as likely to postpone or go without care -If care is sought, twice as likely to go without drugs -Patient Protection and Affordable Care Act mandates that all Americans obtain insurance -a high risk program is available for those who have pre-existing conditions. This will be phased out -plans will not be able to refuse coverage |
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*Final PQRS Body Mass Index (BMI) screening and follow up is to be reported how often? |
Once per calendar year |
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*Final PQRS Documentation of current medications is to be reported how often? |
On every visit |
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*Final PQRS Pain assessment and follow up is to be reported when? |
On every visit |
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*Final PQRS Risk Assessments for falls is to be documented when? |
Once per calendar year. |
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*Final PQRS Falls plan of care is to be documented when? |
Once per calendar year. |
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*Final PQRS Functional outcomes assessment is to be reported when? |
On each visit |
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*Final PQRS Chronic wound care is to be documented when? |
On every visit |
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What is the penalty for not participating in PQRS in 2015? |
-1.5% |
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*Final What is the 2014 Medicare therapy cap? |
$1,920 for PT and SLP services combined |
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*Final Group or Concurrent Therapy |
Group - give same therapy to 2 pts Concurrent - give 2 different activities to 2 different pts. |
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*Final Subjective and objective |
S: what the pt tells you O: what you observe and measures |
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*Final APTA |
American Physical Therapy Association |
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*Final Interdisciplinary team |
Many different health care professionals all working towards the same goal. Considered the most effective in today's health care system. |
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*Final Challenges to a new PTA |
Will have to compete against other PTA's and will have to be independent quickly due to the fact there are way more PTA's than PT's. |
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*Final SnNout and SpPin |
Rule out and Rule in. Slide 56 |
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*Final Evidence based practice EBP |
Conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual pts. |
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*Final 4 Steps of EBP |
1.A clinical problem is identified and an answerable research question is formulated. 2. A systematic literature review is conducted and evidence is collected 3. The research evidence is summarized and critically analyzed 4. The research evidence is synthesized and applied to clinical practice. |
