We are amidst unprecedented times in the physical therapy profession. Due to the outbreak of the COVID-19 coronavirus much of the world is focusing on isolation.  At the time of writing this, there is little evidence to know if those measures will have been needed or not.  When there is no map to follow, proceeding with caution is important.  

As a consequence of this isolation, many companies and services have either voluntarily closed their doors or have been ordered to close.  Physical and occupational therapy services are right in the thick of it.  Providers have cancelled many, if not all, appointments. Several are trying to move patient care to virtual visits through telehealth.  Unfortunately this has left many clinics with no work to give their providers.  There are hundreds, if not thousands, of physical therapists and occupational therapists without work.

I would like to propose a possible option for times when work load is down within your clinic.  Now this won’t solve the coronavirus problem. Nor will it give work for everyone in the clinic. However, this is a task that is often rarely done in many therapy clinics.  

What I am suggesting is to use this time for treatment episode (chart) audits.

I understand that with current times, and no patients coming in it may be hard for a clinic owner to pay a therapist to help do audits.  It may be something that you need to volunteer to do. Whether you get paid or volunteer, offering to do this task can be monumental in identifying how well the clinic is doing “clinically” and how providers can improve not just documentation, but function based patient care.  

As a help, I have created an audit checklist of sorts to help you navigate through an audit.  It highlights key information to look for over a patient’s course of care (episode), patterns to treatment and assessments.  It also helps you concentrate the audit on functional progress. Which is becoming more important to show each year.

The audits don’t need to be super lengthy or drawn out.  My recommendation is to audit about 3-5 patient episodes per provider per quarter.  Try to choose a few episodes with many visits and then a few with moderate visits. Look over everything from evaluation to discharge and use the checklist to help. 

Some highlights to look for:

  • Is the provider using functional outcomes (think DASH, Berg, Tinetti, LEFS, ODI) regularly?
  • Is the provider tracking other measures of ability (think 5x Sit to Stand, lifting floor to shelf, time walking, functional reach)?
  • Is care in the clinic just a repetition of the home program?
  • Is there enough time between visits that the patient needs a progressed home program in the next visit?
  • Is the same treatment repeated over multiple visits?
  • Does the assessment summarize functional problems and progress by referring back to an outcome or measure?
  • Did the disabilities significantly improve over expected time frames? (like in outpatient orthopedic care improvement should be expected within 4-6 week time frames)

The checklist goes into more detail to help you identify patterns or lack thereof.  

Why audits can be so important to a clinic.  

Clinics are often so busy that there is little time to look back and see what treatment patterns there are within the clinic; or with certain providers.  Productivity alone won’t identify the quality of care provided. Also, if your clinic struggles with getting authorizations, or with frequent holds and denials by the insurance, it is likely there is an issue with the clinical information in the documentation.  Audits will identify these gaps for improvement. 

Let’s say you have a provider that gets high productivity but their patients are rarely ever officially discharged and they have frequent issues with getting authorizations.  They need to do peer calls with an insurance reviewer often. Their clinical information has to be sent multiple times or additional information is often requested.

It could be that this provider is not using key information in their documentation to show progress.  They are over focused on visit numbers. Their patients eventually just stop coming due to potential over-utilization of care or even under treating.  Auditing a few episodes of care from this provider would allow one to see if this were true or other potential issues.

One big reason for chart audits to catch reasons that increase administrative burden.  Administrative burden is a cost for a clinic. The more work a clinic has to do to get paid for the care provided the worse their margins and profit will be.  So anything that could be causing a delay or stop in authorization from a payer is a cost.  

Clinical notes that lack pertinent information and that do not effectively show the patient is progressing will cause delays or limited authorization.  No authorizations = no money

Chart auditing will also help ensure compliance with applicable rules and regulations.  It will give an overall picture of the level of quality of care providers give in your clinic. 

Offering to do this for you clinic will be a great resume builder and can help you show the boss you care about the clinic and want to stay productive during down times. It may open all kinds of doors for you to help with other projects when the time comes. 

Lastly, chart audits will help identify potential ethical issues such as over-utilization, lack of skill in the care provided, not training caregivers prior to discharge and many other potential issues.

You Can Do This

Eventually, the down times will be gone.  Use these times to look for ways to be better and improve the quality of care you and your clinics provide. 

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