Bob Schaal, PT, decided to invest in tablet computers for clinicians. Small and easy to carry, tablet PCs allow Schaal and his staff to carry up-to-date information from patient to patient, room to room.

Bob Schaal, PT, vice president of development for Nueterra Healthcare Physical Therapy, Leawood, Kan, knows how challenging it can be to run a physical therapy practice. He has developed and owned 12 physical therapy centers in the Midwest. "I felt growing pains with me still trying to treat patients and run the business," Schaal says.

Practice, he believes, is a fine line between productivity and quality. "You won't survive if you don't provide good-quality care, but the days of seeing one patient an hour are gone," Schaal says.

Technology can help to streamline administrative workflows, maximizing the time for therapy and minimizing the time spent on administration. Software programs exist to automate nearly every portion of practice management with the resulting benefits of saving time, reducing errors, and increasing productivity.

Now leading business development at Nueterra, Schaal has implemented software in multiple physical therapy practices; Nueterra is the business partner in 28 physical therapy centers. Schaal estimates that these clinics have about 11,000 visits per month, seeing patients who span the diagnostic spectrum. Though many of the centers are traditional outpatient PT clinics with a focus on musculoskeletal conditions, some rural clinics also see "a little of everything."

"We have just become a huge believer in software and how it can help a practice," Schaal says. Nueterra acts as the managing partner in each clinic, handling the behind-the-scenes development, administrative, business, and managed care support aspects of the practice. "Most PT private practices unfortunately aren't run enough like a business, and we try to create a sound business environment so the PT can focus on the clinical side of things," Schaal says.

Above: Schaal explains the usuage of a software program to a staff member. Right: A screen shot of a software application used by Schaal.

SOUND BUSINESS ENVIRONMENT

Automation can improve a business by removing or reducing manual labor involvement in administration. Electronic processes help to reduce error, improve efficiencies, and provide documentation, and are available for nearly every administrative workflow process. "We rely a lot on software," Schaal says.

Nueterra utilizes TherapySource software from SourceMedical in Birmingham, Ala, to automate clinical and financial processes. The program manages scheduling—"therapists can schedule appointments from their computer rather than sending the patient out to the front desk," Schaal says; registration; clinical documentation; EMR—"drop-down boxes let therapists create a narrative note without typing," Schaal says; billing—information is extracted from the EMR so nothing is missed; and revenue cycle management—reports can be customized and printed at will.

"Just the statistical information that is within the software itself [is valuable] in terms of reports, whether reference reports, accounts receivable reports, productivity reports, or whatever it might be," Schaal says.

SOLID ROI

Schaal notes that sophisticated practice software can have a positive impact on reimbursement. "When we first transitioned to EMR in my clinic, just through the documentation and automation, we saw reimbursement improve by about $7 or $8 a visit, which is huge," Schaal says.

The software first helps reimbursement claims and payment by capturing all chargeable items. "Now, when I see patients, I finish the notes, and the charges are also taken care of because the billing software extracts the documentation from EMR," Schaal says. TherapySource software does not permit the user to close a note unless it is Medicare compliant.

The system also tracks insurance information. For instance, insurance might authorize 10 visits for a patient, after which reauthorization is needed. "The software can warn you at visit seven that you need to reauthorize to continue receiving payment. In the past, you might have seen someone 12 times before realizing they were only authorized for 10 visits," Schaal says. Those claims cannot be submitted.

Other practices have seen similarly positive results. Peak Performance, which occupies 10 locations in central Missouri, experienced a 35% increase in net revenue per patient visit with installation of the software.¹ The Appalachian Therapy Center of Maryville, Tenn, saw a similar increase in per-visit billings, as well as $700,000 in additional billings.²

The numbers matter because many clinics in private practice find it "a fairly expensive decision to make," Schaal says. More sophisticated systems will cost more money. Schaal selected TherapySource in part because it features point-and-click functionality. "For someone like me, who does not type very well, it was the way to go," Schaal says.

Schaal expected an eventual return on his investment, in part because of the many positive things he had heard from other practitioners. "For me, it was hearing testimonials of other PTs that had already automated," Schaal says. They consistently reported the software put them in compliance with their notes, helped improve reimbursement, and increased efficiency. Balancing that against the cost showed a return was likely.

"We felt truly that the expense would be worth it. Even with the upfront cost, it would pay itself off in the end, and it definitely has," Schaal says.

Nueterra does pay ongoing maintenance and support costs that cover telephone assistance and automatic upgrades (but which also mean the company does not need to have someone on staff to handle these issues). To ease the burden of the initial cost for smaller practices, options such as leasing or on-site hosting can help.

WORDS OF ADVICE

When Schaal made his first transition to digital administration, he installed automation throughout the entire practice at once. "We basically implemented everything at the same time: new documentation, scheduling, billing, etc," Schaal says.

Schaal invested in hardware as well as the software, which can be equally daunting expense-wise. If already computerized, practices may be able to save in this area. However, Schaal advises practices to avoid having clinicians share a computer. "They will fight over it," he cautions.

He recommends one computer for each clinician as well as one at the front desk to handle scheduling and billing. "We went with tablet computers for the clinicians, which are very small and easy to carry from patient to patient and room to room," Schaal says.

He also selected an individual to be the main contact person or expert for the system. "Each therapist has the number to the customer service help desk and can call that, but we have tried to define one person in each clinic as the contact person," Schaal says.

If doing another implementation, Schaal would designate this person and perhaps another expert before the installation. "I would implement the note-taking process with one or two therapists initially to have a local 'expert' when transitioning the rest of the staff. We implemented all at once with everyone, so no one was really an expert," Schaal says.

To maximize their return, it's important for PTs to carefully consider their actual needs when purchasing practice software. "Are they looking for documentation, billing, business management, or statistical reports? Do they want to type or use point-and-click menus?" Schaal asks.

PTs should examine the features of the system they are considering purchasing to make sure their needs are matched. And they should check references. "Check with people that have already converted to some sort of software and get an honest opinion," Schaal says.

CHALLENGES

Thorough research can identify the solutions that will work as well as the challenges to setting up those solutions. Schaal believes the biggest challenge lies in transitioning staff. New professionals (translation: younger) tend to be more proficient with technology than older therapists, who tend to be more resistant. "Experienced therapists, like myself, who have been doing it their own way for years and are not used to a computer have a harder time and are less willing to make the change," says Schaal, who acknowledges that the computer experience can be intimidating.

His practice actually lost two therapists who did not want to learn the new system. "Some therapists have been practicing for 25 years and writing notes or using transcription to dictate notes, and to ask them to change can be difficult," Schaal says.

However, once they do change, they rarely want to go back. "Now, with most of those therapists, you can't pull the computer out of their hands," Schaal says.

Those who did make the transition adjusted over roughly 6 weeks. Typically, trainers come in to review the software ahead of time and stay for 2 weeks to troubleshoot. "But it's not until you actually experience the software in the working world with the daily flow of patients for about 6 weeks that you'll really get comfortable with all of its capabilities," Schaal advises.

He suggests that the developers really do try to make it as easy as possible for PTs to document patients and statistically manage a business better, although it is often from a results standpoint rather than an outcomes point of view. "I think that will be a big area in the future, with the software able to demonstrate outcomes in a more objective way than traditional handwritten notes," Schaal says. He also expects programs to match legislative and regulatory changes, such as those associated with pay-for-performance. By managing these functions electronically, PTs can focus on getting down to practice.

Renee DiIulio is a contributing writer for Physical Therapy Products. For more information, contact .

REFERENCES

1. Source Medical. Physical therapy group reaches new heights in profitability: Peak Performance increases net revenue per patient by 35 percent. TherapySource Case Study. http://sourcemed.net/therapysource/integrated-modules/reporting-and-clinical-documentation/. Accessed June 16, 2008.
2. Source Medical. Per-visit billings increase by 35 percent after deploying electronic clinical solution. TherapySource Case Study. http://sourcemed.net/therapysource/integrated-modules/reporting-and-clinical-documentation/. Accessed June 16, 2008.