Integrating the Resident into Private Practice

Integrating the Resident into Private Practice

Wendy Beattie, CPO

Why we have residentsWhy we have residents

We learn from them New people to the profession are more

likely to assimilate into our vision of practice

They keep us sharp

There’s a lot to learnThere’s a lot to learn

DemonstrateDemonstrate

Evaluation Procedures Patient Education Notes Follow up Billing

Next, direct continuous supervisionNext, direct continuous supervision

• Joint evaluation, with discussion, in the room with the patient or afterwards

• Resident does Patient Education with practitioner filling in missed points

• Resident writes notes. (Practitioner reviews notes , writes supplemental notes, cosigns)

Less SupervisionLess Supervision

Discuss cases Provide input when requested Supervise delivery Cosign notes Review coding and billing

Follow-up Treatment Plan and

Practice Management

Follow-up Treatment Plan and

Practice Management

Follow Up Treatment PlanFollow Up Treatment Plan

“Solicit subjective feedback from patient”“Solicit subjective feedback from patient”

Use quotes in chart notes

Charting Functional Level, and Medical NecessityCharting Functional Level, and Medical Necessity

E.g.,Patient walked on uneven ground, walked at various walking speeds, etc.

Patient required custom shoes because of deformity of foot.

Shoe was required for proper function of the orthosis.

All of these must be in the patient notes

General HealthGeneral Health

Need to view the whole individual, not simply the affected limb– Vision– Hearing– Sense of touch– Cognitive abilities– Contra lateral limb involvement– Overall health and prognosis

Reassess patient knowledge and understanding of goals and objectivesReassess patient knowledge and understanding of goals and objectives

Does the patient remember instructions?

Are the patient’s goals and objectives the same as the resident’s?

Document all findings and actions and communi- cate with appropriate healthcare professionalsDocument all findings and actions and communi- cate with appropriate healthcare professionals

Charting skills Copy all letters relating to the patient Chart all telephone conversations Chart all missed or cancelled

appointments

Develop long-term follow up plan Develop long-term follow up plan

Discuss diagnoses Patient Reliability Routine Maintenance Not generally covered in school

Practice ManagementPractice Management

Demonstrate Proper Documentation of Patient History and Financial Records

Policies and Procedures regarding:Policies and Procedures regarding:

Human resource management Business/finance management Organizational management

Insurance verification of benefitsInsurance verification of benefits

Residents must call and obtain benefits verification/authorization for a variety of insurances

Teaches appreciation of front office staff, of complexity and time involved.

Resident must learn to discuss coverage (and lack of coverage) with patients

Resident must learn to discuss coverage (and lack of coverage) with patients

Learning to Educate :Learning to Educate :

The patient, on their coverage

The insurance company, on value of service, on patient needs

Referral Sources, on coverage, including “generic equivalents”

BillingBilling

Discuss philosophy of L codes Difference between coding and pricing Understanding, HMOs, Medicare,

Medicaid and our policies with each

MedicareMedicare

Guidelines Policies concerning Hospitals Rules regarding Skilled Nursing

Facilities Part A vs. Part B

Running a businessRunning a business

Cost vs. reimbursement Understanding the difference between

item cost and cost of delivering the service

Setting prices for NOC items

Necessary to read all incoming literature regarding insurance issues—especially Medicare

Necessary to read all incoming literature regarding insurance issues—especially Medicare

Manufacturer’s recommended codingManufacturer’s recommended coding

Resident must feel codes are appropriate, despite recommendations

MarketingMarketing

Contact with Physicians Therapists Letter writing skills

Read and Follow Manufacturer’s GuidelinesRead and Follow Manufacturer’s Guidelines

To determine need for changes relative to initial treatment goalsTo determine need for changes relative to initial treatment goals

Is the fit appropriate? Formulating plan for necessary

modifications Making necessary adjustments without

compromising function Think before you act

Time Frame Time Frame

One month observing interaction Three to six months joint work Four to seven months supervised work

Being an effective Resident SupervisorBeing an effective Resident Supervisor

Make sure personalities mesh. Ask questions and encourage the

resident to ask them as well. We want the resident to succeed, to not

only pass the exams, but to become a clinician able to practice on their own.

The Key to SuccessThe Key to Success

Get the right resident…