Setting Standards of Care Benchmarks

We need to deliver care in a fiscally responsible manner.

That means we need to deliver great care AND make money!

Setting appropriate benchmarks of expectations upon your clinical team that permits you and them to view what they are doing to bring about a heightened financial viability is crucial. 

I always say that the only way to make more money is to make more money. Don't leave money on the table by failing to set and manage with your Standards of Care benchmark metrics.

Coaching Program #1

Coaching program post-roll #1

Schedule a consult with Shaun by visiting  https://ptpracticesuccess.com

Transcript

0:09

I'd like to go over what I'd like to call setting the standards of care in a practice. And there's a couple of things I want to really pay attention to on this particular video that I hope you can like really drive into your practice because it really does make a big difference. So we'll jump right in. Okay, so the objectives are simple. We want to provide our patients with compliant quality care in a fiscally responsible manner, and we want to achieve great clinical outcomes. That's what we want. That's what everybody wants. So we have to look at like seeing patients seeing a quantity of patients, but also being able to document and code in an intelligent way. So the organization is doing well financially. You know, 1 of the things we have is our cost of living and everything is going up. Goods and services cost more. Unfortunately, we have an insurance environment that actually doesn't give us any cost of living boosts. So where we make this up is in certain degrees of efficiency and really knowing how to play the healthcare game. No patient will ever come back to see you because of your modalities. That's for sure. They come back because of your skill, your hands on, your caring and your progression of case. Okay. So I'm going to go over the fundamentals of a standard of care. So when I say like, what is quality care? You know, we provide quality care. How do you define it? Oftentimes after you ask that question, you hear like silence for a few seconds while people are trying to figure out how would I define quality care? So we call it a standard of care. And this is not necessarily your practice's standard of care. This is one I could recommend to you. Based on best practice. It includes manual therapy and exercise based approach, right? Hands on. Has a comprehensive patient care delivery model. It's a flexible model that's tailored to meet the patient's needs. It has a functional and wellness component. It's a holistic approach to general dysfunction and deconditioning. It's like a whole body, man. Not just the shoulder, but every part of it, right? And then ideally what we want is An optimistic recovery, that's basically the simplistics of what we call in a standard of care. Then we have to kind of define these points and what is the quantity and quality of these particular points. So we want to look at a couple of key questions. How long should a patient be in your clinic each visit? We're going to clear that up, okay? What percentage of the units charged should be skilled units? Ideally, all of them, right? So how many skilled units per visit do you charge We can take a look at that. By looking at the code, you can kind of see that the patient's progre progressing. That's key. I worked in private equity where we bought physical therapy clinics. I did that for a number of years and we grew to 187 locations in 15 months in 23 states. And within that we had our own EMR. And I was able to see from the coding alone, not the notes, what patients are being progressed. And what patients were not being progressed in their care. So, if I can see it, I imagine insurance companies can too. So, our code should change as our patient's case improves, right? So, how much focus do you put on setting functional goals and structuring your care in order to achieve them? Do you place in your plan of care at every appropriate opportunity a cardio component that's tied to a functional goal? Is there a weekly review and progression of the patient's home exercise program with the patient? And is it documented well? Okay? As the patient improves, do we increase the activity and involvement of your patient? If so, could I see that solely by looking at your charges? Very important. Is your patient in education adequate and engaging enough to prevent attrition? where they just roll off, right? So, the characteristics of standard of care, patients are seen for 60 to 75 minutes on an average. It's a hands on component in every treatment. Clinicians utilize a wide array of time based codes in the treatment session. There's a functional component that's based on the rehab goals of the patient. There's a strong cardio component. It's included in the patient's rehab program. And there's a weekly review. In progression, the patient's home exercise program. A strong and engaging patient education components and modalities are not used in the 60 to 75 minute range. They'd be used in addition to that time period. So we're going to want the patients to get a very full treatment in your clinic. Part of the reason for that is many fold. One, insurance companies commonly limit the number of visits you can see the patient. So you got to make the most of the time you have with that patient. Short visits in and out. You still only get 10. You still only get five. So you should make the most of that, that's for sure, right? And when you're looking at, truly looking at the entire individual when you put together your plan of cares in the treatment of whatever their condition might be we, we become more creative as clinicians and we're providing other services like cardio and, you know, more functional activities, right? In a progression of care. In the beginning of care, we're likely to be more hands on. The patient is in pain, likely has restrictions. You may only be able to provide therapeutic exercise and manual therapy. This is about, you know, they're basically counting the ceiling tiles. They're laying on their back, right? But as the case progresses, you can increase the patient's activity and participation level. So you utilize a wider array of time based codes, such as therapeutic activities, neuromuscular education, gait, you got it? So it should, you know, and I'll also add in, less than 50 percent of your time codes are therapeutic exercise and manual. That's an ideal that we want to look for. For, in order to achieve this in the, in on the left side in the very beginning with very little active treatment, a lot of passive treatment laying on your back kind of stuff, right? So as the patient progresses, we're doing more active treatment, less passive. So in the very beginning, the and manual as a patient progresses, more therapeutic, more kinetic activities, excuse me, therapeutic activities, neuromuscular reeducation, gait. So in this situation, we have what are your top five codes? Well, what we're looking at, I always like to look at what are we, what are we charging the most? Are we charging mostly skilled or unskilled? So if we look at the top five, in this particular therapist, only two of the top five most commonly selected codes are skilled time codes. Right. This is a lousy therapist. I know because I fired them, right? So two out of the top five codes were time codes and 99 percent of the time codes that were selected was Therax and Manual. Now, Therax and Manual is important to note actually does not pay as well as neuromuscular re education and therapeutic activities. Why? Because therapeutic activities is more functional. Those those codes are selected because you're improving their reaching, sitting, standing, walking all the I N G codes. You're improving functional as you improve function insurance companies like that. So if you're actually doing that and you're not in, you're building therapeutic exercise. Well, it's poor coding. It doesn't look like you progress your patient and the organization actually makes less money per visit. Even though you think it should like, you might even consider manual therapy should pay really well because I got my hands all over the patient actually. No, it doesn't. It actually pays less than improving function. Neuromuscular reeducation and therapeutic activities actually pay less. is more engaging for the patient. Insurance companies recognize that that gets the patient back to function faster. They'll pay more for that. Very important to note. So in this particular therapist, only two out of five were time codes. 99 percent of the time. They, they selected, they lay on the back, look at the ceiling codes of therapeutic exercise and manual therapy. Okay, how we take this other therapist four out of the top five codes that he most commonly selected was were, excuse me, skilled codes, time codes, right? Four out of five. So five out of six actually are actually are skilled codes that he most commonly selected. However, And we look on the right side, we have therapeutic procedures, therapeutic exercise, 388, manual therapy, 186, therapeutic activity, and it goes down. Now you're going to tend to see it shaped like that a little bit, to some degree, but what we have here is 79 percent of the time he still charges Therax and manual. Not an ideal coding structure. So when we look at benchmarks to predict successful outcomes, we need to establish whatever those things happen to be, right? So these would be kind of benchmarks that I would look at. How many visits per week expectation per FTE? What is the arrival rate? What is the average patient frequency? Meaning, how many times should a patient come in per week? Right? What is your visits to discharge? How many skilled units per visit are you choosing? In your top five codes, what percentage of the time do they represent skilled codes? 4 out of 5 times? 4. 5 out of 5 times? That would be interesting to know that. You have somebody pushing a lot of modalities on people. Well, maybe they need it. Most likely they don't, but you definitely are generating less revenue per patient. Your clinic, clinical efficiency, which is a percentage of a full schedule, right? So we look at that for the overall, right? And then time codes of therapeutic and manual. So ideally, these are just benchmarks. They don't have to be your benchmarks, but we're looking at 60 to 65 patient visits per FTE. Or 1. 5 and slightly above per hour. We want arrival rate at 95 percent or greater, right? 92, pretty easily attainable. 95, takes a lot of work, right? Average patient frequency, minimally greater than 1. 8. Ideally, about 2. 1 to 2. 2, okay? I have a, certainly an abstract I can share with y'all. That will walk you through the, the impact on successful patient outcomes by improving the patient frequency. Okay. Our visits to discharge 12 plus, you know, 12 to 15, usually pretty good skilled units per visit, minimally greater than 3. 8. Our top five codes. Minimally four or five ought to be skilled. Our clinical efficiency or percentage of our full schedule should be 95 percent and the time codes of therapeutic exercise and manual therapy should be under 50 percent of the codes that we want to want to see. So if I was evaluating kind of clinical performance. Overall, I would look against these kind of benchmarks. How are we doing? How am I doing? If I'm a clinician, you know, my business to discharge run around 12. I'm doing about four skilled units per visit. All my codes are skilled codes. My schedule is pretty full as far as efficiency goes. I see the numbers I need to see, you know, life is good, you know. However, If I maybe I'm the same seeing the visits and everything else is not so good, well, that could be a problem too. But it may not be related to your performance as a clinician. If you have so many patients and just not enough room in the organization to see all those patients, you know, you might have a high cancellation rate, but every single spot on your schedules jam packed. Well, that's a problem of recruitment. You know, that's not a problem of productivity from a clinical perspective. So the benchmarks that we look at for successful patient outcomes is that the average patient that comes into your organization, ideally on day one, should get an eval and two skilled treatment codes minimally on day one. The reason I like two skilled treatment codes versus, I don't know, maybe they're pretty acute and you wanna put modalities on'em or something like that. The two skilled treatment codes are key. The eval, of course, as we know, is untimed, but the two skilled treatment codes allows you to build rapport, and it dramatically improves your chance of a second visit no show, no show after the initial evaluation significantly. We've definitely got the numbers to show that, versus a therapist who does the eval, one skilled code, and one modality. We want our patients to cancel less than 5 percent of the time. We want them to arrive to therapy 2 3 times a week, minimally, greater than 1. 8. We want patients seeing 12 14 visits to discharge. And They're in the clinic for a while, you know, they're, they're moving and moving and grooving. Now, if you got a tiny little space and a jam and a men kind of tight, this might be a challenge, but you want to have enough time that you have a very thorough treatment of skilled care, home exercise program, cardio, patient education, ideally four codes per visit, right? If that's what we, if we could do that. And less than 50 percent of our time codes What would to in order to denote per case progression are therapeutic exercise in manual and that part of less than 50 percent is key as an insurance company, and I'm going to look at something that looks hinky. I look at, do we use the same codes and are we not showing progression? Have I seen that patient for a long time, and we're not showing any progression? It starts with a coding, and then your documentation needs to back it up. So you'll need to establish functional goals so you can tie in your therapeutic activities in order to do that. Now for the, that would be the average patient. So what we want in the clinician is going to achieve all of this above on each one of his patients, and then he sees 12 to 14 visits per day, right? Ideally, We'd also have them have a written success story or a testimonial or something from the patient at every you know, somewhere in the patient's file before discharge, somewhere along the line, they say, I can finally lay on my right side without pain. And you say, well, my goodness, you should write that down so I can share it with your doctor. Right? And they tell you, Okay, and then you do so at least one of those, right? So lastly, intelligent selection of correct CPT code with supporting documentation can make a massive difference in your bottom line and better the overall standard of care. I want you and all of those that work with you to play to win. All right, thank you very much.