It's a good news/bad news kind of thing.
The bad news is that there are still some people—maybe some of your own patients—who continue to think of physical therapy clinic as the health care equivalent of a mechanic's garage: you don't stop in unless something's not working, and when you do come in you try to get out as quickly as possible and hope you'll never have to come back.
The good news is, that attitude is changing fast—and PTs themselves are responsible for a big part of that shift. The profession doesn't just seek to "fix" people, but to optimize movement, to maintain that optimal movement, and to help the public understand how movement is crucial to overall health.
One of the latest ways that the profession is making its mark in prevention and wellness is something that at one time seemed unheard of: the annual PT checkup. It's an idea that makes a lot of sense, particularly in an aging population. And it's also a tool that can help you diversify your practice.
APTA Senior Practice Specialist Lisa Culver, PT, DPT, MBA, has been a champion of the annual PT checkup, and she was instrumental in developing the association's online resources in this area. She thinks it's an idea ready for prime time.
"The annual PT checkup provides something that no other health provider checkup provides," she explains. "By using the movement system as the lens to look at how a person's doing, we can play a part in disease prevention, help patients take better control of their health, and avoid or better manage a lot of chronic conditions." She added that the checkup is intended to go beyond an evaluation of the movement system for function, and into areas like whether a client understands the levels of physical activity necessary to help them fight chronic disease.
Great idea, right? But wait: before you add the checkup to your list of services provided, think about the following checklist.
Understand what you're getting into.
Seems obvious, but take a moment to think about this: are you sure you know how an annual checkup would be done? Do you know which tests you'd use, and how to interpret them in the context of a checkup? If your screening identifies a risk, for example, do you know where you'd refer your patient for appropriate care?
A PT may get excited about the idea and start up some process that may or may not be founded on evidence-based practice. But proceed with caution: it's important to understand what's out there—for example, in terms of tests and measures that have been validated—to be sure that you're providing an appropriate and worthwhile service.
Your best source: APTA's Annual Checkup webpage is your jumping-off point, but you should also be conversant with best practices. Once you feel comfortable with that information, you'll be able to put resources such as APTA's annual checkup form template to use.
Identify your target market.
"The population you start with will likely depend on your current patient population," Culver says. It may make sense to start with your discharged patients, their friends, and family—people who are already familiar not only with what physical therapy can do, but with your clinic or you personally. Another possibility: look around the community for defined population centers that might benefit from access to a PT checkup—senior living communities, for example, or agencies that serve individuals living with chronic disease or disability.
Set your fees.
This isn't a matter of simply picking what seems like a "reasonable" amount to charge—and it may not even be a matter of simply calculating your own costs. The local economy, your target market, and your overall business plan can make a big difference in the fees you set.
Bottom line: get advice from people in the know.
APTA provides some general advice on fee determination, but it's important to get specific, expert advice in this area, whether that's from in-house resources if you have them, or through health care business consultants. Review APTA's practical steps to opening a cash-based service to provide an annual check up by a physical therapist.
Get your fees.
"The most likely scenario is that the PT checkup will be a cash-based service—at least for now," Culver said. For a lot of practices, that's a bit of a different model from what the PT and staff are used to. It's important to develop very clear written policies on fee collection—policies that are shared with and understood by everyone. The most common approach is to collect the fee at client checkout, but it's not unacceptable to ask for the fee before administering the checkup.
It's also important to have policies in place for instances in which the checkup is not completed.
And be ready for anything. In some cases the checkup can identify a condition requiring additional physical therapist services or referral to another professional for consultation; for instance, during the course of the checkup, the PT might decide that a full physical therapist examination and evaluation for an identified condition is called for. Policies need to be in place that account for how much, if any, of the checkup fee will be incurred, what other services would be reimbursable under the client’s health plan, and whether completing an evaluation for a problem a PT identifies would then be covered.
Understand the connection with insurance.
Your annual PT checkup service probably won't be reimbursed by third-party payers—but that doesn't mean you can forget about them completely. Pay close attention to insurance rules around providing noncovered services to their beneficiaries (yes, these provisions exist). The issue is important enough that APTA has devoted a webpage to information on compliance issues when delivering cash-based services. Check it out.
Medicare, of course, has rules about this sort of thing. An Advanced Beneficiary Notice (ABN) must be completed and signed before you can begin the checkup, even though Medicare will likely deny payment for the service. "Much as we might wish otherwise, for now most health plans just won't reimburse for services like the annual checkup," Culver said.
This article is a part of APTA's "Profession in Transformation" series. Check it out!