Outpatient Care Setting Flashcards
what is outpatient PT?
a facility designed with the space and equipment for patients to perform exercises and functional activities with the focus on musculoskeletal conditions but also includes lymphedema, pediatrics, sports-related injuries, worker’s comp, and women’s health
cost effective opportunity to receive high quality care for their impairments
addresses functional limitations and improves patients QOL for those who don’t have the need for an acute setting level of care
who is involved in the interprofessional team in outpatient PT?
physicians
PTAs
ATs
PAs
SLPs
OTs
insurance companies
what is the PT’s role in management in outpatient care?
communicate, supervise and provide leadership to the clinic staff
oversee patient care and satisfaction (customer service)
direct site policies and procedures
manage finances, billing, budgets and payment services of setting
delegate tasks
hire and schedule staff
advertisement/marketing
what are the management opportunities in outpatient PT?
solo owner of a single practice
large private practice with a single office or multiple locations
manager within a large, national corporate chain
regional manager over several clinical sites
vice president
CEO
what are the biggest hurdles for a PT in outpatient?
direct access
practice w/o referral
reimbursement limitations
insurance authorizations
self-referral
kickbacks
what role does the PT play in revenue management?
equipment decision making
salaries/staffing
marketing strategies/insurance sponsorships
home equipment
researching EBPs to improve pt outcomes
operational and overhead costs
value and billing based on CPT codes
cancellation policy and only allowing pts who constantly show up
productivity standards
what are direct costs?
salaries, equipment, clinical supplies
what are indirect costs?
rent, utilities, office supplies
what is the payment system for outpatient PT?
generally paid either on a fee schedule or a % of charges
Medicare (pays provider 80% and pt is liable for last 20%)
private insurances
self-paid
t/f: private insurances follow Medicare’s 8 minute rule and the copay can vary, being up to $75
true
if paid out of pocket, what is the cost of outpatient PT?
up to $175 per visit
what are the threats to success of the PT in outpatient PT?
burnout related to amount of workload
hiring/retaining qualified providers (therapists with specialized skills are harder to recruit)
attracting new patients
managing multiple patients at one time (lack of quality care for patients)
reimbursement rates/problems working with insurance companies (Medicare Part B “therapy hop” from year to year)
why may someone pay for PT out of pocket?
bc they don’t have insurance
bc they ran out of PT visits with their insurance
