Admin Exam 1

Outcome Assessment (outcome measures)

(an outcome target technique) -Helps demonstrate cost effectiveness of health care delivery -Challenge to demonstrate they are better value than their competitor -Techniques compare result of service rather than the care process -Usually a comparison of financial or clinical outcomes to external (competitor), benchmark (industry standard) or internal (outcome target)

Quality Control

(an outcome target technique) -Technique is focused on standards compliance -Standards set through the organization by way of job descriptions, competency requirements, policies, procedures, protocols (guidelines) -Also set by external sources such as governmental and professional organizations (an agency that sets up the rules- how often to do continuing ed, for example)

R.E. Quinn Management Models

(professor in Business administration at Univ of MI) -In dealing with employees all workers are different- managers need to figure out how they deal with each person ---Open: give the tool kit, expect employees to do the building ---Rational: performance based, structured ---Internal: how are we doing, matters less about how the rest of the company is ---Human Resources

Triple Aim

(quality practice!) -Population health -Experience of care -Per capita cost

Patient Protection Act

(refers to referrer and referee in separate systems) -The "anti-kickback" law -Prohibits payment of a kickback to induce business for services reimbursed under Medicare or state health programs -Prohibits soliciting and receiving remuneration to induce business. (both sides could be punished)

Thorough analysis of regulations governing the type of clinic you wish to establish

(regulatory pieces) (not part of project) -CMS manuals -Provider manuals -Minnesota Statutes -APTA Guidelines -OSHA Standards -ADA

Stark Law-Self Referral

(services being provided within the same company) -Restricts physicians from making referrals to Medicare and Medicaid providers with which the physician has a financial relationship -Passed in 1989 -Clarifications have been released 3 times -Many loopholes (safe harbor: if the PT is actually your employee)

Chronological resume

(show that you have progressed, promotions, etc) (show potential for growth) -Most common - easiest to write, organize and read (esp from new grads, not much to put on) -Uniform growth and development in work history -Where you were last is well-known (emphasis on when and where)

In Office Ancillary Services

(supposed to be able to help a MD make a dx) -Physical Therapy (and OT and Speech) (note that our primary goal is NOT to help the MD make a dx) -Radiation Therapy (same issue as PT/OT/speech) -Diagnostic Imaging -Laboratory testing -Orthotics and Prosthetics -Durable Medical Good

Clinic Functions & Objectives

(these are the supportive pieces) -Medical record keeping -Reception (whats the traffic flow, how much space do I need?) -Treatment areas -Billing -Management -Conferencing needs (conference/break room, no good place for a meeting) -Staff needs

Market Analysis

(this should be done yearly at least) -What's going on inside the industry and outside? -Who are our competitors? -What trends exist? -What's our reputation -Are we well positioned and if not, why not? -Examine services and determine if they are worth developing or not (maybe there are services that you are doing that you shouldn't be) -Do we have any cash cows? (follow the guaranteed money makers)

Cover Letters

(to some people its important, to others its not) (always do one) -What's a cover letter and how important is it? -Show that you are excited! -Writing and effective cover letter and things to avoid -Creating your Cover Letter -Sample cover letter

Who is part of the organization of risk management?

(usually have many employees that deal directly and indirectly with people at many levels) -Employees -Customers -Venders -Visitors -Interested parties -Stake holders

Economic and financial harm

(when the physician owns the practice, utilization is always higher) -RFP arrangements have significant adverse effects on consumers, third-party payers, and physical therapists. -Results of previous research studies indicate over utilization of PT services in RFP settings -Anecdotal stories exist of purposeful underutilization of PT to support surgical practices

International health care market

(why do we are about this...) -Patients (we need to understand the cultures that our patients are from, differing sets of values on life and dealth) -Colleagues (also may be from other parts of the world, internationally trained) -'Mission' opportunities (understanding how health care works in a different setting) -Travel (what if you need health care in a foreign country!)

Why is Risk Management a big deal now?

-70's-80's ---Increasing number of lawsuits against health care organizations and workers ---(PT has also gained a lot of freedom/decision making capability) ---(People started to question their health care) ---Entertainment glorification ---Media magnification -In response, health care organizations/providers initiated risk management programs

Health Care in the U.S.

-A BUSINESS -An INDUSTRY (people don't like health care to be called an industry, BUT its still a business, need to make a profit to keep the doors open!) -Has dual components: Public (Government) and Private -NOTE: the amount of uncompensated care is increasing in hospitals (hospitals eat this cost) ---50% bad debt (many of these people are underinsured) ---50% charity care (ex: treated MA patients, get less than you charge for)

Leadership

-A great leadership is not merely a series of mechanical tasks but a set of human interactions -Goal is to stimulate and guide an organization in a desired direction -Leaders can be followed voluntarily out of loyalty, respect, and trust...OR by intimidation and fear of undesirable consequences -Successful organizations recognize value in its leaders and routinely invest in their development -2 types of leaders: formal and informal

Budgeting Strategies: Information summary

-Charges per Unit Of Service (UOS), fee schedule -Equipment charges, DME sales -Volume of services/equipment to be sold (medical sales are 100-150% markup) -Payer mix -Case mix -% deductions based on payer type -Amount of anticipated non-operating revenue -Planned salaries and increases -Average hourly rates by job category -Others (glad you are treating patients???)

Personal Choices

-Choose to own your profession -Choose to be an autonomous practitioner -Make wise practice choices: ---Don't let money be your decision-driver ---Don't let short-term monetary gains outweigh long-term risks to career and profession ---Don't fail to investigate ownership

Mission Statement checklist

-Clear statement of purpose and priorities -Reflects the values/beliefs (culture) of the organization -Presents unique attribute of the organization -Infers the role of stakeholders in the organization -Generates commitment and pride in the organization -Consistent with legal and corporate requirement of the organization

Assess the community demographics

-Community need -Community support -Age -Prevalence of diagnoses -Accessibility

Reporting Compliance

-Compliance of reporting is estimated to be poor -5-30% of adverse patient occurrences are actually reported in hospital settings -WHY??? people may not think that they had anything to do with it, pt may insist that its not a problem, afraid that the pt wont come back, don't want to tattle, no standard definition ---Lack of understanding of what is an incident ---unclear reporting processes ---fear of liability ---fear of relationship problems

Value Added Services

-Compliment the physician to the patient -Provide articles that support timely referrals and evidence informed treatment -"Lunch and Learns" -Seek to develop programs in conjunction with physicians (care or educational) -Send patients to that physician (referrals go both ways)

Government Health Care

-Funded by taxes -The government becomes the third-party payer -More than Medicare and Medicaid -Military and veterans, Federal and State employees, Prisoners, Native Americans, and others -The Federal government is a HUGE 3rd party payer. -Socialized from the standpoint that the government controls the services, but private sector providers still provide some of the care.

Storage

-General storage -Linen storage - clean and dirty (shouldn't be the same room) -Coat closet - staff, clients, and visitors -Small/office supply storage -Ambulatory device storage -Casting/splinting supply storage

A Physician's Perspective: Surgeons

-Global payment: lump sum for the surgery and 90 days post (don't get paid for things in 90 days) -Low payment if they just refer or manage, more money if they do imaging or injections

Health care and the changing social/political climate in the US

-Growing criticism from consumers (because of the expense) -Providers unhappy with regulation/reimbursement (people don't want to go to their primary physician, don't like the way that they are treated) (one of the areas: musculoskeletal problems!) (increased documentation, decreased reimbursement) (providers are doing more for less) -Increasing number of uninsured (to what extent are you insured? Lots of gaps and disparities) -Access to care is diminishing (physicians are pulling out of medicare, this increases the problem of access) -Escalating costs (increasing!) -Hurting the American economy (how can our businesses compete on a global level, when they have to pay these large amounts for health care)

Cost of People...

-Health care is a human resource intensive industry -High percentage of health care cost comes from employing people -Salaries, benefits, recruitment, training, retention, employee health, workers compensation -Impact of cost must be offset by an amount of or increase in productivity

Examples of not-for-profit businesses include

-Health care organizations -Religious communities -Churches -Professional associations -Government operated organizations -Charitable organizations -Community service organizations

Government Ownership

-Health care organizations directly owned by the federal, state, or local government and indirectly by the residents within that government's jurisdiction (a little more nebulus) -Governing body of the jurisdiction, either directly or indirectly (through government/contract employees) is responsible for operating the business in a way that meets the community needs -Example: Medicare billing is to an intermediary (delegation of responsibility)

ATPA Vision 2020

-Helped drive change to the academic programs -Incentivized BS, MS PT's to 'make the grade' -Helped guide efforts for Direct Access -Helped formulate expense strategies for lobbying and other professional projects

A Physician's Perspective: Primary care

-High volume driven -Procedure driven (fee for service) -Time counseling and managing conditions is not reimburseable -Reimbursement is so low that they are having to sell to big clinics -EMM (eval and management) code ($42) vs injection ($130) -Need to see 40-60 pts per day (about 7 minutes per pt) -Not reimbursed for management/coordination (transport, getting social services)

PAID Media Advertising

-Impersonal communication -Expense varies depending on reach -Can reach a large audience with little effort -Can control the message -May reach some who are not potential customers -Requires repetition (need it 7-10 times) -Hard to measure results (how did you hear about us? For most people its kind of unconscious, no memorable moment in time that they limited it) -Limits in healthcare policy - no "deals" (anti-kickback laws make it so we cant do sales, coupons, etc)

Risk management desired outcome

-Improve quality of care -Protect organizations assets

Reform Efforts

-In 1974 Richard Nixon's proposal to require employers to cover workers died in Congress -In 1979 Jimmy Carter's proposal for an employer requirement died in Congress -In 1994 Bill Clinton's plan, which included an employer requirement, died in Congress -Trying to get good coverage for those in non-union employment situations -In 1997 Clinton and a Republican Congress agreed to expand coverage for low-income children (sCHIP) ---Idea: if you keep kids healthier, they will be healthier adults -In 2003 George W. Bush wins passage of the Medicare prescription benefit (but there was no provision to negotiate prices) (not allowed to negotiate prices like the VA) -In 2009 Barack Obama proposes to cover the uninsured and contain costs (universal coverage) (extremely controversial) ---2010 PPACA passed (Patient Protection and Affordable Care Act) -2012 Obama is re-elected -2012 Supreme Court Decision - ACA is Constitutional -Congress has voted 38 times to repeal ACA, most recently in Spring 2013.

Time for a boss to know they will hire someone, interview length

-In a survey of 2000 bosses, 33% claimed that they know within the first 90 seconds of an interview whether they will hire someone -The average length of an interview is approximately 40 minutes (longer interview = better performance

STEP 2: Risk analysis and options

-Incidents prioritized based on potential for severity of financial consequences and/or likelihood of recurrence ---Cost of compensation to harmed party ---Cost of training, equipment, monitoring policies -Risk Management ---Questions to ask for prioritization of options: ---Frequency of occurrences ---Severity of loss(es) ---Possible severity of loss that could have occurred ---What was the effect of past occurrences of this nature ---Likelihood of reoccurrence ---Effect of reoccurrence -Preventable risks identified in step 1 -Risk issues analyzed in step 2

Category of risk: property

-Physical structure and equipment (Broken sidewalk, poorly lit stairwell, loose leg on table) ---Flooding ---Equipment (user error or equipment failure) (when something is broken take out of use, get repairs) ---Pathway/ease of access ---Maintenance and construction, state of disrepair (Armor-All example) ---Lighting ---Throw rugs, carpeting

Differential Marketing Advantage

-Point of Differentiation from Competitors -Providing a different service, or -Providing a service differently (3M example: no copay, no barriers, came sooner, got better faster)

Project planning components

-Pre-work: choose team members, develop committee, design development -Exhaustive planning: financial analysis and budgeting, formal tracking process -Construction and equipment purchase -Pre-opening analysis (see other card) -Marketing, Occupancy, and Start Up (see other card)

Evaluate the population characteristics

-Prevalence of diagnoses (case mix) -Transportation and access (external/internal) -Volume and intensity -Major equipment requirements (pool, special work out area, etc) -Support staff requirements (PTs and other personnel)

Risk management program intent

-Prevention -Control (can make changes when necessary) -Monitor (ex: hospital acquired infections)

Health Care Industry Ownership

-Private Providers and Payers ---Controlled by owners/shareholders/boards of directors ---For profit and not-for-profit -Government Providers and Payers ---Paid for by taxes ---Controlled by the government ---Not-for-profit in MN

Marketing Process

-Process starts with understanding the customer (who's my audience? What do they need?) -Identifying customers' NEEDS/WANTS -Developing/offering products/services that have relevance -Communicating that relevance

Performance indicator: Efficiency

-Productivity hours paid per billed unit of service (UOS) -Non-productive hours paid per UOS -Visits per referral -Visits per referral with demographic specific -Billed UOS per visit

Other parts of a resume

-Professional Associations (optional); at the bottom (call it "professional affiliation and certifications" -Licenses or Certifications (optional) -Honors/Awards (optional) -Community Involvement/Volunteer Work (optional) -Additional Skill Sets (optional) -Computer skills, technical skills, urban planning, leadership -Personal

Cost/profit centers

-Profit centers: ones that MAKE revenue (fundraising committee in APTA, PTs in clinic) -Cost centers: ones that SPEND revenue (research committee in APTA, laundry in clinic) -True cost centers will have only expenses associated with its budget -Profit centers will have both expense and revenue components with its budget

What is a mission statement?

-Provides a current path to realize the future -Clarifies its legal and moral role, what it ought to do -Two edged sword - creates a standard and expectations (internal and external) ---When achieved - boosts morale, strengthens the company ---When not achieved - damaged reputation, untrustworthy

The For-Profit Business

-Provides goods and services for the purpose of making money for its owners -Private and publicly traded businesses can be for-profit -Many health care businesses are for-profit; therapy and other practices that operate long term care facilities, home health agencies, and therapy contract services

Determine primary and secondary referral sources to your clinic

-Proximity (how close are you, can you communicate with MD, how convenient is it for the pt to go to PT?) -Network -Physician group -Specialty area -Relationship

Resumes: purpose, things to consider

-Purpose ---First impression (unless you also did an online app) ---Promote curiosity ---Secure an interview -Things to consider ---Short screening time ---Used to screen applicants OUT (not IN) ---Reflect your BEST ---Integrity - never lie or misrepresent yourself

Qualities of a leader

-Purpose driven -Emotional -Fulfill mission -Inspire risk -The big picture -Do the right thing -The future

Underlying Principles: MN APTA Peer Professional Practice Review

-Quality improvement NOT utilization review (still up to the payer, BUT they give a statement on what was there and what's not) -Applies to all practice settings -Applies to direct patient/client management -Applies to internal and external reviews -Ongoing development and revision by MN APTA members

Pressure that the American health care industry is under to change the way health care is delivered

-Quality of care - personnel, equipment, policies -Value of care ---Patient - the difference the experience made for them ---Payer - the cost of the service delivered/outcome (example: ACL home program results (6 visits) did just as well as those who got all the other visits (25+) -Access to care - location, wait time

What Else Do Physicians Want from PTs?

-Rapid resolution of conditions (find a mentor) -Resolution of tough cases (get a mentor) -Few restrictions or barriers to scheduling PT patients -Satisfied patients -Evidence-based treatment with predictable results -Reliable and useful data on patients (communication)

Human Relations Management Theory

-Recognizes the importance of dealing with needs of individual workers -Demonstrates concern and consideration of employees feelings and personal needs -Non-monetary rewards, recognition -Make employees feel good (increases engagement) -Falls short of substantial inclusion of employee in decision making process

5 Questions most likely to be asked at an interview

5. Tell me about your experience at _____________________ 4. Why do you want to work for us? (I read that ____, and that's really important to me; I have some good friends who have had great things to say about you) 3. What do you know about our company? 2. Why did you leave your last job? 1. Tell me about yourself (professional, undergrad, how you got interested in PT, had some great experience volunteering, ready to find a permanent OPPORTUNITY)

Human Resource Management Theory

-Recognizes the importance of meeting workers need for recognition, inclusion, attention, contribution (use their skills to make the business run better) -Recognizes that workers want to develop and use their skills -Contention that employee satisfaction comes from sense of accomplishment rather than external reward -Greatest benefit when full employee participation encouraged -'fully engaged'

Procedure once report is completed

-Signature of person completing report (signing is only acknowledgement that an event occurred, not on the validity of the report, etc) -Statement/signature of person involved in incident -Give to designated person in specified time frame (ex: 24 hours) -Report usually given to risk management, quality assurance

S Corporation - the minus

-Similar to C Corp, high regulations and restrictions -Margin tax and watchdog process (if you have more than 25% of profits going to personal income for 3 years, you are automatically switched to C corp) -Also has ownership restrictions; limited to 100 individuals who are U.S. citizens or resident aliens

Why is the health care system in trouble?

-Fragmented system, rigid specialization, poor accountability -Resistance to implementation of patient centered information systems -Limited financial incentives to improve quality and safety -Medical liability system - impediment to uncovering and learning from errors

Organization

"a group of people united in a relationship and having some interest, activity, or purpose in common"

Key Patient Information (What do physicians what to know from us about the pt?)

-Pain: Is the pain less? -Functional Status: Can the patient do more? -Satisfaction: Is the patient happy?

The need for people in an organization

-Fundamental element/asset to every organization -Values shape an organization, creating and following the vision of the organization -Leadership of successful organization commit both attention and resources to organizing and fully engaging its resource of people

Financial Variance Analysis

-Performance monitoring techniques all have one thing in common; they look for deviations from what was planned in order to identify potential problems (or opportunity)

Management theory: hierarchy of human needs

-Period: 1950's -School of leadership: Behavioral -Key points: Behavior of leaders and how they treat followers

Management theory: open & closed systems

-Period: 60's and 70's -School of leadership: contingency -Key points: leadership effectiveness of path - goal theory

Management theory: theory Z - employee loyalty through satisfaction, morale

-Period: 70's and 80's -School of leadership: skeptics of leadership -Key points: leader is legitimized when characteristics match followers expectations

Management theory: learning organizations

-Period: 90's-? -School of leadership: contemporary -Key points: leaders seek challenges, take risks, anticipate future

Management theory: Absolute Authority 'one best way'

-Period: Early 20th century -School of leadership: trait -Key points: 'Great Man,' born, not made

So, you want to assess the quality of your PT practice......what will you look at?

(1) Outcome measures (a piece of the picture) (2) Pt satisfaction (3) Employee satisfaction (4) Evidence based (5) Appearance, equipment (6) Documentation quality (7) Performance measures (8) Revenue/number of patients (9) Safety (staff, patients) (10) Efficacy (11) PT-PTA relationship (2 PTAs per PT, observe every 6 visits) (12) Reimbursement (13) Continuing education, certifications

In Service Marketing - 3 Additional Key Factors

(1) Physical evidence of quality and effectiveness (they assume competence, but testimonials are more helpful than posting your certification) (2) Personnel providing the service and their selection/training (you need the right PTs and support staff) (3) Processes that instill consumer confidence (clean environment, nice handouts)

5 Key Factors in the Marketing Mix/Plan

(1) Product (characteristics) (2) Promotion (communication of benefits and use of persuasion) (easy for us- because this is educating!) (3) Pricing (positioning) (although, this is weird for us because it is determined by the 3rd party payer...) (4) Place (geographic/facility) (people assume competence of PTs, they choose on location then) (5) Packaging (special features) (whats the culture? Is it a nice place to be?)

Basic categories of risk

(1) Property (2) Employee benefits (3) Liability

Where are these "standards" and "guidelines" that we use for peer review?

(1) Standards of Practice (2) Guidelines of PT Documentation of Pt/Client Management (uniform for all settings and payers) (3) Documentation Review Sample Checklist (shortened version of #2) (edit so appropriate for your field) (4) Defensible Documentation for Pt/Client Management (APTA and HSO (liability insurance) developed this based on lawsuits over 10 years → had the PTs documented differently, many lawsuits never would have happened) (has regulatory and payer-specific things in it, unlike the Guidelines of PT Documentation of Pt/Client Management) (also discusses specific settings/payers)

2 questions Kathleen asks regarding marketing

(1) Who is my audience? ---All to often the materials speak to someone, but they give it to someone else ---If you are sending "skip the dr" materials to the dr to give ti the pt, that's not going to work (2) Whats my message? What do I want to deliver? What will make a difference?

Questions for Governments worldwide regarding health care....

(1) Who should receive it? (is it a right or not?) (2) Who should pay for it? (an economic reality) (3) How much to provide? (or how little, again somewhat economic, but also political)

Public Relations

(like sending information to a newspaper/TV station for a press release) -Relationship between the organization and the public -Credible because it is not paid advertising (its free!) (you don't necessarily control the message or the timing) -Impersonal -Can go either way (good or bad) -Difficult to control message and timing, or measure results

Personal selling

(a relational experience) (this is kind of the "old way") -Personal process on a person-to-person basis (individual contact) -Content of the message can be customized -Requires knowing or getting to know the customer's needs/wants -Expensive (time and the right people)

Waiting space

(aesthetics) -Clients -Care partners -Others (who is coming with the pt? you want a space for them during the tx)

Marketing purpose

(all of this is predicated by the notion that there is a free market/free choice) -Moves the prospective customer from awareness of the product/service to making the sale -Involves knowing where the customer is on that continuum -Relates to product development and to basic business decisions = strategic (decide which of your services you will market intentionally) -The main purpose of marketing is to drive customers through your door -Must be able to deliver what they WANT and NEED

Performance Improvement (also referred to as Total Quality Management (TQM) or Continuous Quality Management (CQI))

(an outcome target technique) (customer surveys) -Attempts to proactively meet customer needs -Indicators selected for their relationship to high volume, high risk, or high value activities -Patient satisfaction surveys

Other space needs

(costly, but produce no revenue) -Lunchroom -Rest room -Staff lounge

Support staff

(develop an organizational flow chart) -Clerical staff -Clinical staff -Management -Medical director (appointed to see clinic operations, usually a MD) (chart reviews, quality of care) -Other personnel using facility

New Referral Source Program

(each company has its own process for this) -Any new referral source or one that hasn't referred in the past 9-12 months -Not always sure how they wound up in your clinic (by direct referral or by direct access) -At minimum, a new referral source should receive a packet of information about your practice ("sales collateral") -Best case, a hand-delivered initial eval and a chance to meet the physician in person -Thank you or personal note

Work Experience

(focus on what happened in the last 10-15 years) (maybe leave out if a job is irrelevant, but include it if there is a gap... try to list higher-level tasks) -Clinical/Rotations: where it was, what you did ---Equipment used ---Procedures ---Include the full name of the clinic or site, and city -Work experience ---Include name of employer, city, state, dates, and position title ---Use present tense in current position, past tense after that. Start sentences with action verbs. ---Description of the employer - optional ---State position scope or overall responsibilities / duties ---Accomplishment statements - measure in specific terms such as increased productivity, reduced cost by fifty percent, improved morale, etc. ---Quantify in accomplishment statements

Traditional Management Theory

(hive mentality: queen bee and worker bees) (manufacturing is a classic example) -Elements of Darwinism, people of superior ability should lead those of lesser ability -Peak performance achieved when each employee required to perform a minimum variety of standardized tasks on a repeated basis -Boring!!!!; need to provide decent physical environment, efficient technical support and processes, close supervision -Management style is authoritarian and directive (fairly close supervision) -Employee recognition limited to adequate pay (personal recognition is uncommon)

Resume Education

(in about 5 years, move this to the bottom) -Education information should be post high school -List highest degree first -Include name of educational institution, city, state, degree, major/minor, and graduation date. Graduation date is optional. -May include additional information like GPA, internships, study abroad, honors/awards, involvement, etc. -Keep GPA on for <5 years (regardless, people may not like to see that) (don't have to include it- personal choice)

SWOT Analysis

(lets you look internally (first two) and externally (last two) at your business) -Strengths: basic internal building blocks upon which to develop further programs and/or services -Weaknesses: internal areas for improvement -Opportunities: external situations that could be used to the practice's advantage (where are the opportunities?) -Threats: external situations that could negatively impact future development of the practice (ex: things that take time, but don't end up being profitable)

C Corporation

(most common (likely 70-75% of companies)) -Legal entity, separate from owner, must be formed under state law -More expensive option due to incorporation fees (usually a financial consultant or attorney is involved) -Attorney is not required but is advisable (complex situation, cant handle it alone)

Research and project the costs associated with clinic establishment

(necessary for building a new clinic) -Construction -Renovation -Expansion -Utilities

Operating Indicators

(not looking at $, but like visits per patient type, could say how much revenue was from that though) -Tools beyond financial report/statement items that health care uses for evaluating business performance -Includes such things as: ---Referrals - date, day, time ---Admissions - how was clinic selected ---Visits - payer source, physician source, case mix, type of service, visits per referral, cancellation rate, UOS per visit/admission ---Revenue - gross and net revenue per (admission, visit, UOS), gross revenue per FTE ---Cost - labor cost per FTE, benefits cost as a % of salary, case cost by DRG, case cost by payer type ---Efficiency - annual/monthly break-even, time to schedule new referral (process), time from referral to appointment (availability/access), UOS per clinic hour ---Service utilization - visits per patient type, UOS per patient type, referrals by contract, visits/UOS by contract, patient type by contract

Referral sources

(note: all varies by state law and insurance policies) -Primary Care physicians (family practice and internal medicine, osteopaths, podiatrists) ---Definition: can order meds and imaging ---We are not primary care providers, but we can be front-line providers for certain things -Specialty physicians (ortho, neuro, plastics, cardio-pulmonary, oncology, derm, occ. Health, OBGYN) -Dentists -Advanced practice nurses -Physician's assistants -Public

Performance indicator: Revenues

(number of CPT codes used) -Net revenue per referral -Net revenue per visit -Net revenue as a percentage of charge

Performance indicator: Volume

(number of patients seen) -Referrals -Scheduled treatments -Billed treatments -Visits -Case mix

Five Main Health Care Systems

(on a spectrum of all government to no government (privately owned clinics/etc)) (1) Communism (2) Socialism (3) Comprehensive (4) Welfare (5) Entrepreneurial

Resume Highlights / Skills

(optional) -Summarize competencies, accomplishments, or personal/professional characteristics ---Headline or ticker ---Bullets ---Table format

Practice Planning - equipment

(policies for equipment checks, know potential risks) -Mat - hi/low table (much easier for you and the patient) -Plinths -Weights -Bikes -Parallel bars -Hot/cold packs -Traction -E-stim -Ultrasound -Goniometers -Utility carts -Gait belts -Balance -Tape measure -Theraband -Wound care supplies -Furniture

Safety

(posters should be easy to read and reference) -Fire - emergency exit signage, extinguishers, emergency lighting; usually specified by Fire Marshall -Disaster - facility escape plan posting -Security - lighting, lockable files/areas

Selling or Sales of PT

-Focuses on the purchase (apposed to marketing, which focuses on the person) -Involves arranging the exchange and negotiating the details of that exchange -In PT: make an appt. or make a referral -Hard to measure sales, but is measured by number of new patients (how much sales?)

Resume Objective/Professional Summary

(you want employers to see what YOU ARE BRINGING, not your career goals as much) (do a sentence or two and then bullet points) -A brief statement about your job search goal -What do you have to offer? -What will you bring? -How can you add value? -Strengths and achievements -Easily understood and focused (Can include the objective in the professional summary)

Facility planning Space utilization

** E = TO/UA** -E = cubicle required (how much space do you need?) (think about all the people who will be in a tx room) -T = treatments that will require cube space -O = occupancy time for Rx of 1 client -U = utilization - portion of day cube is in use, generally use .80 (lunch time, documentation note time, cancellations/no shows) -A = available time per day per cube (hours you are open)

Vision Statement checklist

**Clear, vivid picture of the organization's intent and future** -Challenging -Hopeful -Memorable -Realistic -Achievable -Guides the long-term action plan

Criteria for Standards of Practice for PT

**The profession's statement of conditions and performances that are essential for provision of high quality professional service to society, and provide a foundation for assessment of PT practice** -Good for peer reviewing others and as a baseline for developing a practice -Sections (not all inclusive) ---Ethical/legal ---Administration of the practice (mission and goals?) ------Organizational plan (procedures for the development of a practice) ------Administration of the practice ------Fiscal management ------Collaboration with other professions ---Pt/client management ---Education (we are responsible for our own professional development) ---Research ---Community responsibility

Budget

-"Annual financial business plan" -represents managements best estimate of what will happen in the short term future, -Internal benchmark against which the "time to time" (week, month, year, etc) performance is assessed

Loss Reduction

-"CYA" (watch your back) ---Be prepared in case there is a claim ---Have all records completed in a reasonable time frame ---Inform staff of claims that have been filed ---Staff education regarding legal action and processes ---Revise procedures that have led to occurrences and adopt new policies for occurrences that were not addressed

Referral for Profit (RFP) Definition

-"Referral for profit" (RFP) in physical therapy describes a FINANCIAL RELATIONSHIP between a physical therapist and a physician in which a physician (medical doctor, doctor of osteopathy, podiatrist, dentist or chiropractor) REFERS A PATIENT for physical therapy and derives a FINANCIAL BENEFIT from the physical therapy services provided to the person who is referred - POPTS ≠ RFP (a physician COULD invest in a PT practice (POPTS) but not refer to it)

Manager Models

-(1) Affiliative Power Managers - want to be liked more than they want to get the job done, make decisions based on what makes people happy (ex: even when they are already short staffed, they let people off) -(2) Personal Power Manager - strong boss who makes employees feel strong, democratic but self-aggrandizing, often friction between departments (can create friction between departments) (ex: performance reports from different clinics) -(3) Institutional Managers - service to the organization, mature, eager to recognize and reward performance, puts the organization and the good of its people first

Socialization goals

-(1) Cooperation, cohesion of employees needed by employers to get the job done -(2) Job satisfaction to prevent staff turnover -(3) Morale and productivity of individual employees (no 'bad apples') -(4) Interaction among employees with their supervisors (respect, trust, commitment)

Managing Financial Performance: Four-part process

-(1) Financial management planning -(2) Annual budget planning -(3) Performance reporting -(4) Performance variance analysis and corrective action as indicated

Hospital strategies for meeting complex organizational, market, and reimbursement issues

-(1) Network/Alliance: independently owned hospitals that collaborate to centralize functions and improve effectiveness and profit -(2) Systems: single ownership organizations with multiple units, result of creation of new organizations or acquisition and mergers

Women as leaders

-2002 to 2004 % of women in executive, administrative, and manager positions went from 18% to 46% -Broken "glass ceiling" ---Greater equality of roles in performing household chores ---Decline in the average number of children ---Education level increase ---Gap between women and men in math and science scores has decreased ---Working women value the same things as working men

Common nonverbal mistakes made at a job interview from a survey of 2000 bosses

-21% Playing with hair -47% Having little or no knowledge of the company is the most common mistake job seekers make during interviews (it is expected that you know about them, mission statement, values, etc) -67% Failure to make eye contact -38% Lack of smile (changes your voice and your whole demeanor) (esp for a phone interview!) -33% Bad Posture (they want to see confidence) -21% Crossing arms over chest (looks close minded, etc) -9% Too many hand gestures (sparingly) -26% Handshake too weak (you extend your hand first!) -33% Fidgeting too much

Statistics show that when meeting new people the impact is:

-7% From what we actually say -38% The quality of our voice, grammar and overall confidence -55% The way we dress, act and walk through the door (dress up one level from the job you are applying for) (conservative jewelry, not flashy)

Referral for Profit Agreements: Possible scenarios:

-A physician has an ownership interest in a physical therapy practice to which he or she refers. -A physician or the physician's practice employs or contracts with physical therapists to provide physical therapy services within the physician practice. -A physician's income or bonus is directly or indirectly tied to the revenues of the physical therapy service to which he or she refers patients

Health Care or Physical Therapy as a Commodity

-A service or product that is not differentiated from competitive offerings by any characteristic other than PRICE -Insurers want us all to be the same, want it all evidence based and standardized (the worry is- when we are all the same, the next step is that someone else can do it (takes no thinking, someone less expensive could do it)

Insurance in 1965 - 1980

-A shift in social philosophy significantly impacted health care during this period (becoming a very wealthy nature post war) (felt the obligation to take care of others that could not care for themselves) (not up to the individual) -Prevailing social philosophy was one that included a sense of needing to care for those who cannot take care of themselves -In 1965 Lyndon Johnson won passage of Title XVIII (Medicare) and Title XIX (Medicaid) (human rights, civil rights, war on poverty) ---Medicare was designed to keep senior citizens from becoming poor

Ethical Considerations (code of conducts)

-APTA Code of Ethics and Guide for Professional Conduct: ---PT shall seek remuneration as is deserved and reasonable for PT services (Principle 7). ---Disclosure to patients REQUIRED if referring physician derives compensation (7.1 B). -AMA: "under no circumstances may physicians place their own financial interests above the welfare of their patients."

Risk Management - Examples

-Abuse -Non-compliance with ADA -Anti-trust violation -Assault and battery -Breech of contract -Credentials of medical staff (only appropriate things should be delegated) -Discrimination -Fraud (ex: medicare decides that your mistake is "abuse" or "fraud") -Informed consent -Sexual harassment -Theft -Workers compensation -Infection rates -Professional malpractice -Quality assurance

Chart of Accounts (like a dewy decimal system- number takes you to a place)

-Account is a category of asset, liability, owner's equity, revenue, or expense -Chart of accounts is simply a listing of all the business' accounts -Think of as a set of files, each holding only the information relative to the label on the file -Numeric code assigned to each of the files (accounts) (allows you to add incoming checks/bills where they belong) -New sub accounts can be added or subtracted to reflect the business' current financial operations, however the primary account designations should not change -(you can always add new accounts, but cant get rid of them (need to keep the records of where money was))

Income Statement: Expenses

-Accrual - expense should be recorded in the time period the service or item is produced (expense incurred) -Cash - expense recorded when the bill is paid -Many more ways for a business to spend money than there are to make money ---Optimize revenue, but also look to where you can cut costs (which may be cutting staff)

Income statement: revenue

-Accrual - revenue should be recorded in the period when the revenue is made -Cash - revenue recorded when the revenue is received -Revenue recorded for items with associated discounts should be recorded at the discount price or appropriate deductions made in the accounting (not how much you are charging for the service, but how much you will likely get reimbursed) -Revenue for assumption of risk - relatively new to health care, characteristic of capitated payment arrangements ---If you get $X for a pt, you have the incentive to get them better quickly

Methods of Accounting

-Accrual: matching ---Revenue is recorded within the period it is earned ---Expenses must be recorded within the time period they are incurred ---Example - MNAPTA Spring Conference (payments or bills may come in before or after the event, but they are all posted to the month of the event) ---Importance in reviewing business performance ---Accrual is used in healthcare because so much of what we do is events or projects -Cash (this is what we are used to thinking about, like a check book, in "real time") ---Alternative to accrual method ---Revenue is recorded when cash is received ---Expenses recorded when bills are paid ---This approach fails to match revenue and expenses, will not support management effort to determine costs of individual products or services ---Used on a limited basis in health care, mostly in small private practices and partnerships

Revenue Management

-Actions taken to increase the total revenue and improve collections of accounts receivable. -Increase volume (to bill for more you need to increase volume) ---Add to referral base (ask referrers why referrals have slowed) ---Expand services/programs (make sure that you have trained PTs who can lead these) ---Add staff (but make sure that there is space) ---Extend hours of operation (evenings, weekends)

Leader vs Manager

-Administer: to impose or formally apply -Manage: to control, direct, conduct, bring about -Lead: to guide, direct on a course, bring to some conclusion -Leader - somewhat vague, who are they, what do they do, where do they live, what can they do for me Manager - interactions often not pleasant, where you go for complaints, if good experience, don't think much about them

'Portals' for incident information

-Administrative and department managers -Quality assurance -Financial services managers -Medical records manager -Social services manager -Public relations / marketing -Chaplin service director -Case managers -Admissions clerk -Aides, orderlies, CNAs -Security officers -Maintenance personnel -Volunteers -Discharge clerks -Voluntarily terminating employees -STUDENTS!!!

Pre-opening analysis

-All mile stones met -All equipment lined up -Paper flow and billing system in place -Policies and Procedures in place -HR functions covered -Regulatory/compliance assured

Product Mix

-All of the services and products an organization offers that contribute to the specific goals of the organization -Portfolio is based on diversification (risky to just do one thing)

During the interview

-Arrive early, but not too early (10 min) -Greet each person pleasantly (write down their names, say names again in the interview) (include the receptionist!) -Follow the interviewer's lead (go along with their small-talk) -Look professional and travel light -When asked a question, take a moment to think, don't be afraid to ask them to repeat part of the interview -Ask meaningful questions (who do the other PTs interact with during the day other than pts?) -Ask for the job

Early History of insurance

-As early as 1920's there was concern amount the ability of an individual to pay the costs of HOSPITALIZATION. -The way hospitals/payment worked changed when the iron lung and penicillin were invented (thanks to technology there were increases in uncompensated care) -The first hospital PREPAYMENT plan was founded in 1929 at the start of the great depression (caught on across the country as "insurance") -The plan was established to help Baylor University Hospital which was in serious financial trouble due to patients not being able to pay for medical bills -The payment plan was successful and the idea of prepayment plans quickly caught on around the country -As the number of prepayment plans grew, standards for performance were established through the efforts of the American Hospital Association (formed to make sure that they didn't get taken advantage of by insurance companies, developed standards, asked insurance companies to abide by that) (hospitals and insurance companies both needed to keep each other in check- both trying to make money) -Several plans organized under what is now known as the Blue Cross-Blue Shield Association -Today the BCBS plans are the largest group of the associated health care insurers in the United States -Other such companies were since formed as "Commercial" plans (privately held health insurance)

Cash Flow Statement

-Availability of cash to cover short term business liabilities is critical to operations (3 mo cash flow should be available to cover you with seasonal changes or trends) -Bad choice to make between defaulting on short term liabilities or liquidation of assets -Report used to track the sources, use, and availability of cash

Common financial statements

-Balance sheet -Income statement -Cash flow statement

Marketing

-Based on what the "customer" NEEDS -Image building - You must RELATE their needs -What you have is to offer is ---clinical decision making ---service (its about the experience- make their pt better and be hassle free) -Branding - the customer's PERCEPTION (thoughts and feelings) based on reputation

Interviews: presenting your best self (before, during, and after)

-Before the interview ---Self assessment ---Research ---Practical Issues -During the interview ---First impressions ---Being the best candidate -After the interview ---Review and follow up

History: MN APTA Peer Review Professional Practice Review

-Began in 1980; developed by MN PT's (under constant review) -First edition Peer Review Manual, April 1982 -Revisions: January 1983, 2000, 2008 -About 130 trained reviewers -Provide services for: ($100/hour for peer review, peer-reviewers ~$40) ---PT's ---Consumers ---Regulatory agencies ---Investigators ---MN Board of Physical Therapy: complaints against PTs/PTAs → could set these people on a course of corrective action... ------Documentation/ethics courses ------Shoulder-to-shoulder observation ---Employers (want investigations into documentation for PTs) ---Payers (fraud units- working on lawsuits)

Treatment

-Booths vs curtained vs cubicles -Private treatment rooms -Gym -Hydrotherapy (not used much anymore) -Private consultation/education rooms (ex: joint replacement class) -Pool/other specialty areas -ADL areas (rehab areas- little kitchen, desk (ergonomics type of things) (often done in homes now)) (could also have facilities for work hardening)

Types of direct and indirect costs

-Both are either... ---Fixed - same cost regardless of number of patients who are treated (rent, ultrasound machine) ---Variable - cost increases as number of patients increase (laundry services) ---Semi fixed - wages, salaries that may vary based on overtime, or work hour decreases (may have to bring in extra float PTs)

Interview Clothes

-Bright colors are a turnoff -70% Employers claim they don't want applicants to be fashionable or trendy -65% Employers say clothes could be the deciding factor between two similar candidates

Tax Status

-Business can either be for-profit or non-profit ("not for profit") ---For-profit: want to make money, 35-40% profit (bonuses are possible, good equipment, etc) ---Not-for-profit: you are making money, there is a profit, but it goes back to the company -Tax status determined by two factors: ---(1) Purpose of a business ---(2) How the business will use its profits

Private ownership

-Business is owned solely by an individual, group of individuals, or by another privately owned business -Owners have the right to establish the purpose of the organization, financial return, personnel employment, management strategies -Owner may be directly involved in management or rely on other managers -Unless you are one of the founding members, interest in a private organization can be obtained only through sale or transfer of interest by the existing owner(s) -Conditions for sale are usually restricted by the business' articles of incorporation

Sole Proprietorship

-Business run by an individual or family which does not adopt a formal business structure -Applies to any unincorporated business including private practices of lawyers, accountants, and therapists -Business and the owner(s) are one and the same from legal and financial perspective

Outcome Targets

-Can be used to evaluate an organization's performance -Three techniques common to health care: ---(1) Quality control ---(2) Outcome assessment ---(3) Performance improvement

Cost or Profit Center?

-Can the work of the unit be clearly separated from that of other units? -Do the employees assigned to the unit share common knowledge and skills that distinguish them and their work from others? -Is there an individual or team that has the authority and responsibility for the units performance? -Is there sufficient and reliable information that can be used to separate the revenue and/or costs of the unit from the rest of the organization? -Will separation of the revenue and/or costs of the unit increase management's ability to plan? -Will separation of the unit make it easier to evaluate and improve its performance?

Control Exposure

-Carry out series of corrective actions -May involve personnel,facility/physical location, equipment

Risk Avoidance

-Certain health care services notable for greater frequency of legal action and high dollar settlement (neurosurgery and obstetrics) -Organization may decide not to offer certain aspects of service delivery

Risk Management Programs

-Personnel (you may have people who specifically do your risk management), policies, and procedures that minimize the likelihood of situations that might result in harm to employees, customers, or organization -Protect assets from loss - Property, Money, Human resources, Public opinion

Market Research

-Consider the external factors that are driving physician behaviors (their career is being threatened, other care providers are taking over, reimbursement is down) -What does the physician NEED? (look at their websites) (ask around/ask their staff) ---Who do they use for PT now? Are they happy? ---What types of pts do they see? What are the pts they have problems with? -Find out where the physician is on the continuum of marketing -How much does the physician know about what I have to offer? -Are they close to "buying?"

Marketing communications

-Consider: Who's My Audience? -Consider: What's the Message? -Common mistake: come to XYZ Therapy because we have high tech equipment (doesn't work because it doesn't tell us about their back pain); we should be saying "we can get you moving," "we can reduce the need for meds," LAY IT OUT IN LAYMANS TERMS! (the consumer will be google-ing "back pain" or "thumb pain," not the specific names for what they are)

Medicare

-Considered to be the most important piece of health care legislation ever passed by the U.S. Congress -The legislation was targeted to provide for the health care needs of the elderly -Later Medicare was expanded to include the needs of persons with permanent disability -RISK POOL???? (no young healthy people in this group, almost everyone receives care, this is a BAD RISK POOL!) -Reform: maybe we should dilute the risk pool

C Corporation - the minus

-Corporations are subject to income tax on profits -If after-tax profits are distributed to owners that income is subject to a second personal income tax -More regulations and restrictions (state laws, etc)

Loss Prevention

-Corrective actions include: ---Educational programs and in-services ---Improved communications ---Typed orders ---Preventative maintenance

Annual Budget - Structure

-Cost center - only expenses (no associated revenue) -Profit/revenue center - has associated expenses and revenues

Accrued expenses

-Costs incurred but not paid over a period -Sick time, vacation time (has value and accrues over time) ---These have value to the employee, expense to the company and must be kept on the books until used, at which time they are expensed. -Start up/major expenses, lease ---May choose to spread out the expense over a 'life' of the equipment or asset ---7-10 years commonly used in health care

Institute of Medicine (IOM)

-Created to ensure scientifically based, non governmental generated advice to improve health -2 recent studies... conclusions ---Quality of care highly questionable ---Delivery of care dangerous (more people die in a given year from preventable adverse events in hospitals alone than die from MVA's, breast cancer, or AIDS)

Branding

-Creating a mental and emotional image about something -Positioning of services or products as high quality to influence the consumer to choose that service or product even at a premium price (willing to pay a little more for this brand) -You need to live it or the brand can change: BP gasoline, Livestrong, Nike and Tiger Woods

Market segmentation: what market segments are we targeting?

-Current patients/clients (look what else we can do for your/your friends/family) -Referral sources (we can make this convenient for you) -Public (come straight to us) -Insurers (we can save you money) -Employers

External influences that can impact PT

-Customers (aging community, for example) -Competitors -Political climate (battle for unrestricted direct access or athletic training issues, for example) -Governmental regulations (license renewals, CEs) -Economic climate (strength of the profession) -Technological innovations -Demographic shifts

Elements of a Profession

-DEFINITION: An occupation based on mastery of complex BODY OF KNOWLEDGE ...used in the SERVICE OF OTHERS, whose members profess a COMMITMENT TO COMPETENCE, integrity, morality, altruism and the PROMOTION OF PUBLIC GOOD. Society in turn grants the profession AUTONOMY of practice and privilege of SELF-REGULATION (Oxford English Dictionary, 2002) (so in MN, we are not a profession)

Direct vs Indirect Costs

-DIRECT COSTS: expenses for delivering services, tangible, associated with revenue production ---Salaries ---Equipment ---Supplies -INDIRECT COSTS: 'overhead' or underlying costs, things that are necessary regardless of the number of patients or type of practice (always have a pretty constant cost and influence) ---Rent ---Utilities ---Office supplies ---Janitorial services ---Administrative services ---Medical records systems ---(Marketing) -INDIRECT COSTS that can not be directly tied to a particular department, can be arbitrarily assigned to a department or departments (but must remain consistent), 'shared allocated expense' (take some expenses from something that everyone needs and disperse it (ex: APTA office) (ex: payroll))

Balance sheet liabilities

-Debts of the business, the amount of assets owned by its creditors ---Accounts payable - debts payable to individuals who have provided products or services to the business on credit (examples: insurance, utilities, maintenance, payroll, equipment) ---Accrued expenses - value of debts held for the future (vacation- have to pay it off (the more vacation people don't take, the more they are liable for)) ---Notes payable - loans evidenced by loan agreements and specifics of agreement, examples - line of credit, start up capital, mortgages

Progress / Discharge Summaries

-Deliver in person if convenient and timely -Make it legible -Attach a personal note -Thank them for the referral

Informal

-Demonstrate ability to influence actions of other team members but are not formally recognized in leadership structure -Difficult decision regarding degree of recognition -Can be a great asset or a significant risk

Private Not-for-Profit Organizations

-Formed for reasons other than making a profit -Usually to meet the needs of a particular community or constituency -IRS requires that any profit is put back into the organization rather than being distributed to owners and shareholders -Exempt from Corporate Income taxes (Needs of a community (Shriner's), needs of a constituency (APTA))

Private For-Profit Organizations

-Formed to make a profit -Owner(s) can take the profit for their own use. -Shares in stock may be publicly traded -Owners of stock are called shareholders -Profits (income) are taxed and are paid by the corporation and the shareholders -Shareholders expect DIVIDENDS while they hold the shares and a PROFIT when they sell the shares.

Not-For-Profit Business

-Designated as tax exempt -Exempt from all forms of federal, state, and local taxes -Business must apply to IRS for tax exemption (if they don't grant this, you are for-profit and you will be paying taxes) -Exemptions granted to businesses whose primary purpose is some form of community service -May not provide financial benefit to any private individual or for-profit business -Payment of a reasonable nature can be made to an owner-employee, other employees, or corporate owners -Not-for-profit businesses are required to retain and reinvest excess revenue into the business to support its mission (may be charitable donations, etc) (you cant have excess) -Increased scrutiny over the last past few years due to increasing number of 'not-for-profit' organizations -Decrease in tax base for local, state, and federal bodies with associated expenses for public service (fire, police, parks, roads, city/community buildings) -Health care organizations risk the loss of their tax exempt status if they fail to provider a reasonable level of community service

Corporation

-Done when it is desirable to have legal separation of the business from its owners -Four types of corporate organizational structures: C corp, S corp, PC/SC corp, limited liability corp

Sole Proprietorship - the plus

-Easy and inexpensive to form because you can do it yourself -Provides the owner full control and all the profit -Profit is recorded as personal income

Partnership - the plus

-Easy and inexpensive to form; can be done yourself -Partners have shared control -Profit is divide between the partners, treated as personal income; tax rate of individuals applied to profits even if they differ between partners

Balance sheet asssets

-Economic resources which are owned by a business and are expected to benefit future operations, include such things as... ---Cash ---Investments ---Prepaid expenses (independent contractors, employees' insurance) ---Inventories (crutches, etc) ---Equipment ---Accounts receivable (billing, cash) ---Capital assets ---Building (if owned) ---Intangibles ---Note: things that are not financial assets = PTs, client base

Functional resume

-Emphasizes WHAT you have done (group skills into communication, -More difficult to write and read -Use when next position is not a natural progression, entering job market for first time, gaps in work, frequent job changes (hides your age some)

Market Segmentation

-Established High Value Referral Sources (who sends you everyone they have, and have for a long time) (we forget to tell these people when we develop new programs) (keep this relationship strong) ---NOTE: satisfied = happy, but would still try other things, opposed to loyalty = will keep coming back! -High Potential Referral Sources (don't realize that you could help more pts) -Non-Referring - Unknown Potential Referral Sources

After the interview

-Evaluate the interview ASAP, what were you well prepared for, what needed more preparation, Think about the questions, did you founder with any of them? -Write a thank you note within 24 hours (send an email- mail that comes in will take too long) (appreciated being interviewed, what you learned; sum up who you are and why you are right; last paragraph- looking forward to hearing from you and your contact info) (can say please send this onto the rest of the panel or CC them) -Follow up in a reasonable time (ask before you leave the interview) -Leave the door open for future opportunities (40% of hires don't work out- get a better offer, start and shortly after are fired, quit) → should send a note, say thank you, say that you will be watching for openings in the future, hope to still work in your organization

"Incident to" the Physician's Services (under their billing number)

-Exceptions to Stark allow physicians to bill for therapy services as an extension of their own services (in office ancillary services) (legal for a physician to own and refer to) -Services are either billed under the physician's NPI (national provider identifier) as if the physician did the work OR -Services are billed through the therapist's NPI. The therapist assigns the reimbursement to the physician. (again, the MD gets the money and decides who gets what) -APTA totally disagrees with this

Health care organizations own buildings, vehicles, expensive inventory of supplies and equipment... risk management associated with these items

-Falls in building due to floor/surface conditions -Accidents with vehicles -Malfunctions of equipment (or proper operation) -Loss of inventory/assets through theft or embezzlement

Gifts for Referral Sources

-Federal laws against the inducement of referrals (anti kick back laws) -$300 limit on annual gift -Many clinics no longer accept gifts of any kind

Payment types

-Fee for Service - payment based on full charges -Discounted fee for service - payment based on full charges less a percentage discount (self-referred, don't have insurance) -Cost Reimbursement - payment based on lower of charges or provider's actual cost (Medicare) -Per Diem or Case Rates - payment based on a set fee schedule for inpatient stay, outpatient procedure, or course of care (per diem: per visit or per day of care) (case: bundle or package, emphasis is efficiency of care, slippery slope to poor care) -Capitated Payments - set payment to cover the care delivered to entire set of lives covered by third party payer (unusual, but a new insurance strategy- not per visit or case, but for their members- you get a lump sum to take care of all their patrons that come to you)

Leaders: top list of traditional qualities...

-Finance -Resource allocation (ex: 0-G Treadmills) -Product development -Marketing -Service delivery -Technology/technical proficiency

Accounts Receivable Management

-Financial management of revenue, involves numerous aspects: ---Measuring services and products for sale ---Setting prices for the products/services to be sold ---Setting billing, credit, and collection policies and procedures (examples) ---Invoicing the customer ---Payment receipt management ---Cash management ---Calculations of deductions and allowances ---Payment posting to accounts -Charge Master / Fee Schedule (see excel sheets) is the key element to accounts receivable ---List of all services and products that the business offers to its customers ---Each listing has an assigned numeric charge code, description and unit measurement, and price

Performance indicators

-Financial ratios allow for comparison of current financial performance to past or current performance to expected -Additional financial related performance indicators may of particular value for assessing the performance of a physical therapy practice -PT-related performance indicators ---Volume ---Revenues ---Costs ---Efficiency

Data Presentation

-Information must be easy to obtain and presentable for efficient management use -Must have enough detail to be useful (Materiality: I can apply this detail and make it useful) -Comparative or Common-size reports (comparative = linear (looking back at last year); common size = compare to other clinics, looked at as a percentage of expenses) -Financial Ratios (a type: profitability ratios) (pick the right one for your business)

Financial Statements

-Information used to support and evaluate the direction of the business presented in financial statements and reports -Usually structured to represent a specific time period and reported as of a specific date -Reporting period does not follow a calendar year but rather a fiscal year, may follow a calendar year but can be a 12 month cycle starting anytime throughout a year

Marketing Mix or Plan

-Intentional and strategic mix of services/products predicted to satisfy the needs of the target markets and a plan designed to attract and retain customers (meet the customers where they are at)

Information sharing

-Internal ---Historically has been limited to management ---Recent trend of 'work teams' for problem solving and performance improvement has changes this restrictive-use thinking ---Many businesses now distribute financial information to employees at all levels ---'Knowledge is power' -External: information used to evaluate a business for performance, viability, 'worthiness' ---Government agencies ---Stockholders ---Potential investors ---Creditors ---Philanthropists ---Industry analysts

Risk Management related to information

-Internal ---Previous claims ---Incident reports ---Patient records (problematic for pts to fill out forms in a second language) ---Committee reports (groups analyzing these issues) ---Quality assurance (common tool: pt satisfaction surveys) -External ---Insurance company representatives ---Industry publications (others writing things that are a reflection on us) ---Expert consultants (representatives of the public or companies)

Life Cycle of products, companies, organisms, relationships

-Introduction stage - low profitability -Growth stage - greatest profit -Maturation stage - greatest profit (need to re-establish at this point to keep the maturation going (sustain the business) and prevent decline) -Decline stage - low profitability

Performance indicator: Costs

-Labor cost per volume measure (60-80% normal in a clinic: high rent, expensive professionals/equipment) -Non-labor cost per volume measure (benefits, recruiting, training) -Employee benefits as a percentage of salary: 30-35%

Labor costs

-Labor costs are a significant part of the expenses in a service organization (30-35% of salary) -Labor markets revolve around highly educated, highly skilled providers -Labor costs include ---Salary ---Benefits - vacation, sick pay, disability ins, retirement plans ---Recruitment ---Development, training ---Health

What to do with the completed report?

-Legal experts recommend that incident reports and forms be kept separate from patient care records - WHY? → maintain the treatment documentation as our good intentions (incident occurs outside the boundaries of care) -Potential litigation cases should have reports forwarded to organizations legal counsel - WHY? → in case you do hear from someone's lawyer, we want our legal people involved right away, protects YOU, report becomes property of your attorney and gives them time to organize their case (other attorney cant get it without filing a motion for discovery with the judge) -LEGIBILITY (if you cant read it, it doesn't have legal merit)

Structural references used to describe health care organizations include...

-Legal structure: defines some elements of the ownership, relationship of owners, type of business, and/or the purpose of the organization -Tax status: helps define the organization's purpose and relationship with its owners as well as other individuals and organizations -Operating structure: provides insight into the organization's response to all of the internal and external factors that influence its success

Welfare-Canada

-Less central government, more private involvement (public/private partnership) (similar to the US) -Residents have universal access to health care (like the systems we have already discussed) - referred to as 'Medicare' (for everyone- not just elderly and disabled like it is here) -Providers are not government employees (THIS is how they are different than the previous systems) -Health care is considered a right and is the shared responsibility of the government (s) -Canadian Medicare covers approx 70% of health care spending -Private ownership is ok, people can choose where they go -Increasing numbers of Canadians are purchasing private health insurance -Public insurance pays for care outside of Canada but at their prevailing rate -Long wait for diagnostic testing and care from specialists - average > 16 weeks (not that different from here) -Very few specialists in Canada, geography results in poor access to providers (we get paid what Canada would have paid for their care (usually less $))

Risk Acceptance

-Lesser of two evils -Expense vs. risk -Level of malpractice insurance -Settlement vs. litigation

Levels of communication

-Level 1: broad foundation of information collection about values, beliefs, norms ---Health care: caring for the sick, technology, research ---Patients: hard work, faith-based, thriftiness, safe community -Level 2: information collection of social groups or roles in the culture, categorized by title, job, gender, age, qualifications ---Health care: LPN's, MD's, DO's, PT's, OT's, Housekeepers, Administrators, Ortho Team, NICU Team ---Patients: senior citizens, Baptists, migrant workers, single mothers, football team (demographic) -Level 3: personal information about individuals in level 2 ---Names of individual health providers and patients

Physical Environment

-Lighting (can you dim or turn off lights?) -Heating, cooling -Security, control systems -Communication systems telephone, paging, computer (better to go heavy with this stuff) -Floor surfaces (how do you keep it looking nice) (carpet is safe) (throw mats) -Décor -Traffic flow, accessibility

C Corporation - the plus

-Limited personal liability -Offers ease of ownership transfer and will continue to exist without the initial owner(s) (it can continue on without the initial owner being a part of the process) -Easiest time of raising capital

Framework (phases) for peer review

-Phase I: Review of self -Phase II: Review initiated and performed by staff / peers within a setting or an individual from outside the setting invited to act as an educator or consultant. -Phase III: External request for review by MNAPTA Peer Review

Other Real and Potential Adverse Effects of RFP

-Loss of control (autonomy) of our professional practice (thought of as technicians - unable to think or decide) -Driving salaries downward and increasing fear that PTs will be replaced by other less qualified providers ---Ortho surgeons are really excited about ATs treating pts for cheaper than PTs -"Passive Revenue" (as if the act of referring is a reimburseable service) (PT, imaging, etc)

RFP Detriment to Professional Autonomy

-Loss of independent, self-determined professional judgment -Limited responsibility for all aspects of patient/client management -Inability to refer to and collaborate with health care providers -Makes PTs subservient to physicians -Diminished professional identity -RFP practices do not support the continued growth of the profession (e.g., contributions to PAC and Foundation) -Medical practices contribute to political action funds that oppose initiatives of physical therapy practice (e.g., Direct Access)

STEP 3-5: Choice of options

-Loss prevention -Loss reduction -Control exposure -Risk acceptance -Risk transfer -Risk avoidance

Leaders are expected to...

-Make decisions -Take responsibility for outcomes -Make lots of money... to share!!

Formal leader

-Management structure to coordinate efforts of employees, maximize overall productivity, carry out strategies -Titles used to identify formal management position (President Vices President, Director, Manager, Supervisor) -Responsibilities of those positions vary among organizations -All can be found in physical therapy management

Lighting

-Manner of illumination has great impact on atmosphere (patient comfort) -Appropriate levels - comfortable yet professional -Building code may specify -Most people prefer natural to artificial (use windows when available) -Control of lighting - security and function

Physician Email/text

-Many docs are now giving out their email addresses -Email must be encrypted for privacy -Text messages (a single line allows for privacy)

Business Promotion

-Marketing activities that stimulate consumer purchasing -Trade shows, expositions, health fairs, community outreach programs, sporting event sponsorship, charity benefit involvement -Cost varies (often time is the expense) -Often impersonal (cast a big net) -Easily imitated -Challenge to find the right event (Medtronic = marathon, Tria = hockey tournaments) -Cause marketing (get involved with a good cause, that says something about us...) (not what you do, but who you associate with)

Value statements

-May be broken out of the mission/vision to provide more 'heart string' appeal to consumers -"we believe...", "we value..." -Ideals/items that support the expectation of achieving the mission/vision -Access, accountability, diversity, education, financial success, honesty, innovation, productivity, quality care, respect, teamwork, work/home balance

Goal setting

-Means to control, coordinate, and evaluate work performance -Did we/you do what you said we/you would? -General Rules ---Phrased in terms of outcomes ---Measurable ---Challenging, but realistic ---Communicated (all on the same page)

Medicaid

-Medicaid is a state administrated program -Jointly funded by state and federal governments -Usually more than one plan (Medicaid and Medicare are programs, not insurance companies) -Intended to provide health care services to the poor, elderly, and disabled persons -Supplemental to Medicare, persons can be eligible for both -Federally mandated essential benefit set -Some services are considered optional at the state level and the extent of the coverage varies from state to state, resulting in wide flexibility of benefits -Federal defines MINIMUM COVERAGE that a state must cover (essential benefits); up until recently, PT was not essential (and was therefore always at risk to be cut from the program in MN where it was included) (this is part of the affordable care act (includes rehabillitation and habilitation) -The question now is, the extent to which PT is covered

Administration of Public Programs

-Medicare was (and is) the largest provider of prepaid health care. -The government looked to ally itself with health plan administrators (insurance companies) in an attempt to provide administrative expenses and streamline costs (give them some money for doing the work) -Medicare arranged with BCBS to handle claims (originally, but has since opened up to competitive bidding) -Since then other health plans have been awarded contracts to do the same (will now be NGS (national government services) (changes: iontophoresis will likely not be covered...) -These are called third party administrators (TPIs). (have some risk, but not as much as a normal insurance company)

A Physician's Perspective: General mindsets

-Medication or surgery orientation -A Happy Patient is a Faster Patient (streamline your notes) -Physical therapy service is a reflection on the referral source -All physical therapists are considered excellent or outstanding (competency is assumed) -Which one(s) STAND OUT?

To Profit or Not To Profit

-Money is required for a business to sustain itself -To grow and prosper a business must make more than it spends (profit) -Gross revenue = money earned through the sale of services and products, interest on investments, or contributions from external sources -Money spent = expenses -Gross revenue - expenses = net revenue (this is the profit)

Result of pressure to change in the American health care industry

-More attention to ---Productivity: how many pts, cancellation/no show rate ---Efficiency: how long do pts wait, whats the schedule like ---Customer satisfaction: surveys, was there a nice experience (regardless of outcome) (employees need to be committed to the mission)

Incident report content

-Most organizations have standard form -Be super objective! -Basic information ---Names of those involved (including witnesses) ---What, where, when of occurrence ---Documentation of corrective actions taken -Avoid: interpretive information (cause, speculation)

Resume Heading

-Name -Address (consider not putting it if you are applying for a job far away) -Telephone Number -Email Address

The Continuum of Management Styles

-PUSH (Traditional) (crack the whip) -PULL (Human Relations) (I have expectations, but I will have a leash on you to make sure we go in the right direction) -LEAD (Human Resources) (give employees what they need, but then trust their ability to manage their work) -PUSH ==> PULL ==> LEAD = Autocratic ==> ==> ==> ==> ==> Democratic

Insurance in the late 1970's

-National shift to low paying jobs in the service sector jobs was leaving a growing number of people without health care insurance -Government budgets held down reimbursement under public plans -Health care providers were forced to shift the cost of care for under/uninsured to the private insurance companies. -Employers were faced with significant increases in the cost of providing health care benefits to workers -Medicare and Medicaid reimbursement went down, had to shift cost of gvmt pts to the insurance companies -Managed Care plans were developed to help reduce costs by "managing care." (by HMOs) (health management organizations) (really only about managing costs (pay less or not pay for certain things) -Access to some providers via a gatekeeper and preferred panels of providers (primary care provider gave permission or referral for specialists) ---"Preferred providers": would take less money -Details of each plan limited certain services -Patient pays some out-of-pocket expenses -Minnesota (and California) lead the way on managed care in an effort to contain costs ---Many people ended up underinsured

Why is marketing important?

-Need to let people know what we have and what it can do for them -We want to attract good customers and maintain them -We shouldn't be depending on a different party to prescribe to us, describing what we are ---Surgeon telling the pt that you need to "fail PT" to get the surgery that they think they want/need

Balance sheet swner's equity

-Net difference between the total assets and the liabilities -Can be a positive or negative value, although not 'net revenue' it is a key component in a quick evaluation of a business' vitality with respect to value to owner (comes into play when a person is thinking about buying or selling) -When you start a business it will be a negative number for a while (6-9 mo to hit a break even point)

Types of culture shock

-New employee ---Vacant position filled by interview process ---Staff member added by merger, staff realignment -New process ---Paper/chart system of record keeping ---Paperless medical record ---Changes to existing electronic medical record system -Mystery meetings

Limited Liability Corporation (LLC)

-Newest type of 'corporation' (really a 'company') (20-25 yo) -Owned by its members (co-ops, etc) -Can choose taxation structure -Combines some advantages of partnership (unincorporated) and corporation -Allows for pass through of profit relative to taxation, no corporate double tax -Disadvantages ---Newness of option and lack of legal testing, more costly to set up than partnership ---Variance of state to state requirements (more consistency in the other structures ---More costly to set up than partnership ---Difficulty of raising capital (its not bad, but we don't know that it's a good thing)

Communism-Russian and the former Soviet Bloc

-No right to private ownership (government owns it all) ---All resources belong to the government ---All providers work for the government ---Government finances all aspects via taxes ---Therefore everyone DEPENDS on the government -Health care is considered a right -Free medical services; medications conditionally free -Physical Therapy provided by medical doctors and nurses -Now people do have choice, there is an element of competition -Former bloc countries are now in transition

Ethics and POPTS

-Not all POPTS are unethical -Not all POPTS are illegal (state law and Stark (Federal) law) (they are legal in MN, illegal in some other states)

APTA's Branding Efforts

-OLD: "The Science of Healing, the Art of Caring" (this is not specific, does not set us apart, doesn't differentiate) -NEW: "Physical Therapists help you restore and improve motion to achieve lifetime quality of life." (this describes some of what we do) -Focus groups showed that people understand rehab (something happens, get some rehab); we are NOT well branded in prevention and wellness (some work to do in this area, good potential) -If the public knew all that we could do they would come!

Goal of Risk Management

-Objective has several goals, the most basic of which is to protect from harm or loss -In health care: ---Protecting patients from harm ---Protect both individuals and the organization from harm and/or asset loss

Qualities of a manager

-Objectives driven -Rationale -Fulfill contracts -Avoid risk -Day-to-day routine -Do things right -The present

Structural

-Obvious cosmetic factors: color, texture, appearance -Sturdiness for suspension/mounting of equipment (pulleys, traction, weights) -Height of ceilings (what about jumping with an athletic population)

S Corporation - the plus

-Offers both limited liability and pass through tax treatment for federal income tax purposes (you avoid the double taxation) -Only alternative for a one person company looking for the above scenario (pass through) -Continuity of existence without the founding owner -Ease of raising capital

Physician Encounter

-On site- visit often! (repetition is huge) -Check your schedule and let them know you have openings for a walk-in -Report on a patient status (in person) -Be quick and concise -Ask a question (their approach to something) (work their ego) -Thanks for the referrals

Conflict of Interest

-Once a therapist is employed by a physician or physician group, an inherent conflict of interest exists: ---Physician judgment for need and continuation of physical therapy is compromised ---Physical therapist may face pressure to manage all patients referred by a physician ---Best interests of client may be compromised

Expense Management: 2 types of expenses to control

-Operating - associated with cost of resources; personnel costs; current/real time value -Capital - purchase of equipment; building, machinery; future value; associated with concept of depreciation value (depreciation values: any time you have major equipment, value starts high when it is purchased, depreciates over time (7-10 year depreciation scales- it eventually has no asset/liability value))

Story telling method

-P: problem (try to avoid personal problems) -A: action -R: result (should be positive) -Also, limit story to 30-60 seconds

Compelling Reasons to Refer

-PROBLEMS we can solve for the referral source -NEEDS we can meet -RESULTS we can deliver

Ways RFP could be/has been dealt with

-PT licensure prohibition (holds PT responsible) -Make physician ownership illegal -Payment policy (turn off the revenue stream)

Socialism-Germany and Sweden

-Recognizes the right for limited private ownership (own their own homes, some businesses) -Do not believe that health care is necessarily a right, BUT... Views healthcare as a community asset -A unique feature to socialism is Solidarity (if its good for the country, there is a shared responsibility for it) -Financed by sickness funds (insurance companies that get $ from employers, unions, and professional associations), and some private insurance -Price control on drugs (lowers costs) -Physicians are limited as to where they treat patients -Low administrative costs (all the paperwork is all the same, not complicated, really reduces costs) -More government involvement than private -High degree of patient satisfaction with socialism health care systems -High degree of concern about their sustainability (minimal out of pocket expenses) High level of physician dissatisfaction (underpaid by comparison)

Financial Management Definition

-Refers broadly to the action taken by the organization to obtain and maximize the use of monetary resources -Most obvious aspect of financial management is the gathering and use of financial information

Case Mix

-Refers to the mix of patients by diagnostic groups (how many back pain pts, how many ACL, etc) -Front end - driven by clinic's mission statement and objectives (helps you plan what programs you need to develop) -Back end - help determine equipment purchases, program development, staff training/hiring -Financial - project revenue based on referral patterns

Payer Mix

-Reflects the sources of reimbursement for services provided and billed (how many were work comp, medicare, private) (medicare pts get the clinic less money, some clinics choose to not see medicare pts) -Usually noted as percentage of total payments -Use to identify attractive markets, assess impact on revenue (deductions)

Income statement

-Report covers performance of a business over a specific period of time -Comparison of money earned (revenue) to money spent (expenses) -Difference between the two is the net income (or loss) from operations during the specified period -Income statement aka: earnings statement, statement of operations profit and loss (P&L) statement, revenue and expenses statement ---Note: profit margin can be positive or negative

Why is RFP an Issue?

-Represents control of one profession over another (we are our own profession!) -Real and potential consequences of referral-for-profit arrangements -Physical Therapy - A PROFESSION ---Profession or 'adjunct or ancillary service'? ---Are you preparing to practice as a professional or a technician? ---Only when members of the profession view themselves as AUTONOMOUS PROFESSIONALS will they curtail participation in POPTS

PC/SC Corporation

-Reserved for corporations where individuals both own and provide service in the corporation (service delivery companies (dentist, PT, etc) (not just a business/finance guy)) -Business deductions - health care costs, mileage, equipment purchases, continuing education -Easy to form and costs to establish costs are moderate -All owner-service providers must be of the same profession -DC, MD, OT, etc + PT.......NO! (cant combine multiple professions) -Tax rate for PC/PA/SC is a flat 35% -Other corporate tax rates are graduated and start at 15% (but it could be higher than 35%)

Financial Management Plan: 2 major components

-Revenue management -Expense management

Risk Transfer

-Risk shifted through contractual agreement -Insurance -Out sourcing services, e.g.. radiology

SMART Goal Writing

-S-pecific -M-easurable -A-ction oriented -R-ealistic -T-imebound

How does the public describe us?

-Sage: a wise person, has knowledge to share -Hero: we make a difference in lives, we don't necessarily do it for them, but we are their coach/mentor

Marketing a "Business of One": how do you market yourself?

-Same marketing principles apply during job search (market yourself, make yourself different) -Not about what you want, but how you can help the organization -(1) Know your audience -(2) Refine your message -Why should they care?

Physical Environment

-Schematic drawings (floor plans) -'Functional' area design -Cubicle requirements -How much space should be for tx rooms? Lots of clinics support a "club mentality"

Scope of the income statement

-Scope of the income statement is the whole organization -However, income statement format is also used to reflect the performance of individual sections/components of a business -Example: APTA finance committee gets info from all the committees and displays it on an income statement, so you can see how the business is doing as a whole, but can also see where the money is being spend/made -These discrete departments are usually referred to as cost/profit centers, difference is revenue capabilities

References

-Selection and preparation ---Familiar with your work and will say good things about you, ask their permission, confirm what title/email address/phone number ---Write down your relation to them -Reference list -Final tips -Reference Worksheet -Sample reference list

Mechanisms for assessing quality of PT practice:

-Self review: review our own quality of practice (productivity, pt satisfaction, etc) -Peer review (internal): looking as a PT at another PT's practice, but within your own clinic -Peer review (external): looking as a PT at another PT's practice, outside your clinic -Non-peer review (internal): have a non-PT do the review (OT, speech, nursing); crucial to explain the standards of PT practice to these people so they know what they are looking for -Non-peer review (external): includes state surveys that go in from external environments

Loss of consumer choice

-Self-referral limits consumer's option to choose a therapist ---Patient may not even be aware that conflict of interest exists, or that he/she has a choice ---Medicare law REQUIRES that patients are fully informed of choices regardless of setting - and no pressure is brought upon them -Physician has 'fiduciary responsibility' to the patient

Legal structure

-Several legal structures - best structure is best determined by the business objectives (mission and vision statements) -Incorporation: the process by which a business venture receives legal recognition; desirable should business owners wish to separate organization's legal and financial affairs from their personal ones -Incorporation is governed by state law

Category of risk: employee benefits

-Short, long-term disability -Accrued time off -Retirement/savings accounts

Partnership

-Simple way to structure a business with one or more persons (could have a partnership with just one person) -General (all partners treated equal (same voting power, same liability)) vs. Limited (some partners have X% of a vote or limitations on what the partnership means) (could be a minority partner, for example) -No legal requirements to forming a partnership (don't have to register with the state, etc) (you would draw up an agreement and have it notorized) -Local government may require a partnership to be registered

Before the interview (look up "behavioral interview questions for physical therapists")

-Skills, experience, personal qualities, accomplishments (resume, cover letter) -How will you fill the employer's needs (PAR approach) (tell us about a time that something went wrong) (looking for how you deal with difficult pts, etc) -Feedback from supervisors, co-workers -Research the company, department, position -Practice -Plan logistics (try driving there and getting to the office days before) -Polish your wardrobe (portfolio, extra resumes) (when they call to schedule the interview ask who you will be seeing- a panel? A few individual interviews?) (notepad, jot down questions you may want to ask) (prepare questions to ask! What will orientation be like, what does the ideal candidate look like, what is the time frame in which you will be making your decision) (email if it goes past the time frame: I am very excited about your position and I am wondering if you need any additional information from me) -Prepare your materials

Major external variables that affect healthcare and influence the availability of services and how they are paid for

-Social: distributive justice, is health care a right or a justice (our social norms come into play), value driven -Political: power driven (those in control have the power to make the decision), not philosophical, based on who is in power (campaigns are important - who is elected has consequences for health care) -Economic: you have to talk about the cost of health care (20% of our GDP), budget driven

Market Segmentation Definition

-Splitting the market into separate smaller groups -Looking at each target population as having very specific and often different NEEDS (know the group you are targeting as a group apart from others)

Getting Started Marketing to Physicians

-Start small -Do your homework (understand your audience) -Invest in assistants and office staff -Don't limit your contact with physicians to problems -Nurture the relationship

Balance sheet

-Statement of financial condition that provides information about a business' assets, liabilities, (+ or -) owner's equity as of a specific date (there should be a balance) -Reporting date commonly end of a standard reporting period (quarterly, bi-annual,etc) -Gives a picture of a business' plus and minus aspects at a glance -Format is represented by the equation Total Assets = Total Liabilities - Owner's Equity

Traditional problem solving system usually employed for risk management (5 steps!)

-Step 1: Risk Identification -Step 2: Analyze Options -Step 3: Select Options -Step 4: Implement Choice -Step 5: Monitor and Improve System

Comprehensive-United Kingdom

-Still based in socialism concepts but varies from other European countries -Feel that everyone is entitled to complete care -System encompasses entire national population of several countries (England, Wales, Scotland, Northern Ireland) - National Health Service (NHS) -Financed through general taxes (86%), payroll taxes (12%), fee for service for dental services and prescription drugs -Every provider is a government employee (no privately owned hospitals or clinics) -"General practitioners" are the gatekeepers for specialty services or hospital care (complaint: slow progress to getting to the specialist) -Specialists are paid salary -Generalists are paid per patient and are paid for keeping pts healthy -Moving down the spectrum toward more private care -Cost effective - health care provider wage set with negotiations with NHS -Outcome effective - 81-91% patient satisfaction (adequate) (this would not be acceptable in the US) -Fast and comprehensive response to serious condition, but slow to diagnose them (esophageal cancer ex)

Public ownership

-Stock representing an ownership interest is traded to members of the public through a stock exchange -Publicly traded business is owned by a diverse group of individuals who have elected to invest in the business through the purchase of stock -Management of publicly owned businesses are accountable to their stockholders to provide a return on their investments -Return on investment can be provided through an increase in the value of the investment or through payment of investment income; 'dividend' -Laws that govern publicly traded businesses are regulated through the National Securities Exchange Commission (Martha Stewart)

Leaders are masters of...

-Strategic planning -Persuasion -Negotiation -Speaking -Writing -Listening

Critical analysis of existing services (SWOT)

-Strengths: basic internal building blocks upon which to develop further programs and/or services -Weaknesses: internal areas for improvement -Opportunities: external situations that could be used to the practice's advantage (where are the opportunities?) -Threats: external situations that could negatively impact future development of the practice (ex: things that take time, but don't end up being profitable)

WHAT IS PEER REVIEW?

-System by which peers (same profession, same clinical practice area, rural/urban) assess the quality of physical therapist practice -Peers using common standards of practice and guidelines to evaluate practice -........is this preferable to non-peer review? (benefits of both) -........why or why not? (nursing comes from a different practice model)

Communication

-Technology should be built into clinic design - much cheaper on front end -Liberal dispersion of phone/computer jacks -Intercom/paging system (paging is common) -Overhead background music (nice vs distracting) -Staff mailboxes

National Coalition of Health Care (NCHC)

-Watchdog group of > 100 organizations, seeking to improve health care in the US -Health care spending 16% of GNP (~ $2 trill dollars), est $4 trill by 2015 ---Medicare Crisis (baby boomers looking for additional health care because they are looking to maintain quality of life and activity level) -NCHC position: current system is inefficient, poorly managed, and unequally distributed (underserved areas)

The 6 components of a properly written goal:

-The PERSON (ie: patient, client, spouse, PCA, NAR, etc.) -The BEHAVIOR (ie: functional limitation level - ambulate, transfer, roll, etc.) -The FUNCTIONAL OUTCOME (ie: functional limitation level - in order to ambulate to the bathroom, in order to self-groom, in order to reach plates in the cupboard, etc.) (ie: disability level - in order to return to job as a cab driver, in order to return to providing daycare for grandchildren, etc.) -The CONDITION(s) (ie: with minimal assistance, with a 2-wheeled walker, on level carpet/tile, with manual assistance of spouse, with x% of verbal cueing, following self-performance of ROM exercises, following a 10 minute application of ice, etc.) -The MEASUREMENT CRITERIA (ie: degrees of ROM, MMT measurements for strength, distances for ambulation, pain scale rating, etc.) -The TIMEFRAME (ie: in terms of days, weeks, number of treatment sessions, etc.)

Organizing

-The act of applying systematic planning and a unifying effort towards the arrangement of independent elements into an interdependent whole -Dynamic process: new projects, new processes, new surroundings, new work group, new customers -Management systems drive the machine -Management efforts to accommodate external change have left many health care organization in a state of continuous organizational restructuring

Market Share

-The percentage of a defined market that is served by a given organization -Ways to increase market share are: ---(1) Market penetration (a bigger piece of the pie) (take pts from others) ---(2) Market expansion (a bigger pie) (coming up with things other than rehab that we can do)

Cost analysis

-The process of determining the expense related to the production of a product or service: ---Cost information used to manage expenses and set prices ---Critical importance in negotiating contracts for participation with managed care systems -Note: cost of service can run 60-80% of what you charge (cost of operation)

Importance of Design in practice planning

-The quality and design of our work place has a direct influence on the quality of work produced and efficiency

Marketing, Occupancy, and Start Up

-Thorough analysis, plan development, and marketing plan implementation -Assure clinic functions -Open house / kick off -Develop clientele -Evaluate effectiveness and implement change

Errors in practice planning

-Traffic flow patterns (tight corners, add mirrors) (don't congest walkways) -Geographic location of treatment areas (if you don't has space for performance measure, you cant do it) -Structure limiting function -Inadequate storage -Noise levels - no quiet work space (no spaces to be making important calls vs have casual conversations) -Inappropriate staffing level (do you need to carve out specific "management" time?) -Inappropriate equipment (pricey equipment not being used)

Health care is a rapidly changing industry.......True of False.....Why?

-True: new technology, new research, evidence based/best practice -False: takes so long to implement everything; creating technology/research/policy takes a long time

Revenue Management - Price Increase

-Under current health care reimbursement, a price increase may have a limited effect on net income ---price sensitive market - 'over pricing' (patients are not very well informed- because pts haven't had to pay, insurance took care of more) (pts are starting to feel like cutting cost) ---price insensitive market - 'fee schedules' 'allowables' may negate price increases (wont even make a difference, medicare is the best example) (where the "discount rate" comes in) (work comp is 100%, private insurance is 80-90% (other part comes from pt, that's where bad debt comes in))

Insurance in 1965-1980

-Under reasonable cost payment methods of insurers/payers, providers were encouraged and financially rewarded for providing services and as a result there was a flourish of growth in health care delivery systems and facilities (we just sent in the bill and got paid!) -Consumers, free from most or all of the financial responsibility, were encouraged to utilize the expanded health care services (because it was paid for, everyone just went) (some people over-use or abuse healthcare) -Employers were starting to realize that they were footing the bill, costs were going up -Many people were still uninsured (cost kept going up and they had no way to pay for it)

Partnership - the minus

-Unlimited liability -Partners directly liable for business debt and expenses, personal assets at risk -Partners are jointly and severally liable, all partners are wholly liable even if due to actions of another partner (if something goes wrong, one person could be sued as an individual, or both of you could be sued as owners) -May have difficult time raising capital (high failure rate, banks wont have much faith in you, unlikely to give you a big loan) -Partnership can not provide tax free benefits to the partners

Sole Proprietorship - the minus

-Unlimited liability; owner directly responsible for all debts and expenses -Personal assets (savings, home) are at risk (basic living expenses would be left) -Can not provide tax free benefits (health and life insurance) to the owner (even if you pay for your employees health care plans) -May have more difficult time raising capital

Insurance in 1940's - 1950's

-Up until WW II the individual was responsible for the premium or cost of the care coverage plan -After WW II, employers began offering health plan premium payment (health care) as a benefit to attract good employees -Employer-sponsored insurance plans continued to grow and it became a fringe benefit under most union contracts -But not everyone was covered -In 1950 Harry Trumans' proposal for national health insurance died in Congress (this has been a long debate in the US)

Common speaking points in a mission statement

-Values -Identity/image -Services provided -Area served -Employees/staff -Resources (location, equipment, etc)

Supply costs

-Vary greatly between organizations -Therapy practices generally have 4 categories ---Office supplies ---Medical supplies ---Minor equipment (linins, towels) ---Supplies to be sold

Qualities that leaders should be demonstrating...

-Vision -Passion -Sensitivity -Commitment -Insight -Intelligence -Ethical behavior -Charisma -Courage -Tenacity -Humility (at times)

Entrepreneurial-United States

-We value INDIVIDUAL success, based on free market capitalism (competition) -Unique health care system -Tax supported (public), but mostly privately supported (both from provider and payer sides) -Reflects the economic theory of capitalism -Public component has evolved to care for elderly, disabled, and poor (and veterans and federal and state employees) -1/3 government to 2/3 private (less government involvement that previously discussed systems) -Most responsive -Most technologically advanced -Some of the worst outcomes (despite spending SO MUCH!)

What constitutes QUALITY physical therapist practice?

-What makes one practice high quality and another NOT high quality? -After all, WHAT IS quality ? (see below) -What if we all define quality differently? As a profession we lack credibility (pts, payers, legislators, etc) -Does any of this really matter anyway? Yes - health care reform (change is not a new thing, but now the public is more involved)

Marketing a Service vs. a Product

-When a service is sold, there is no exchange of ownership (opposed to a product- you could touch something, try it on, bring it back) -Services are kind of invisible- the product is our intellectual property (clinical decision making!) -Customer satisfaction is determined by the OUTCOME, the EXPERIENCE, and to some extent, the COST

Mission and Goal Alignment in practice planning

-When evaluating facility and equipment needs, it is essential to analyze how they will support and promote the realization of the organizations values, vision, and mission

Questions to ask yourself when you start writing your resume

-Who will be reviewing my resume? (don't use the same resume for each application) -What specific skills do I have to offer? (highlight the skills/experience they are looking for) -Do my competencies match the job requirements? -What is the best way to state these competencies in my resume? (top half of the resume)

Category of risk: liability

-Workers compensation - injury on the job -Office liability - theft, embezzlement -Professional negligence - malpractice

Purpose of MN APTA Peer Professional Practice Review

1. Educate physical therapists 2. Educate payers regarding the value of physical therapy 3. Answer community concerns about the quality of PT services

Top Ten Most Common Mistakes Made at a Job Interview

10 Over -explaining why you lost your last job 9 Conveying that you're not over it (don't say negative things about anything from your past) (should look like you are excited to move forward with your career) 8 Lacking humor, warmth or personality 7 Not showing enough interest or enthusiasm 6 Inadequate research about a Potential Employer 5 Concentrating too much on what you want (salary and vacation are not discussed until the offer has been made) 4 Trying to be all things to all people 3 "Winging" the interview (think about your strengths and weaknesses ahead of time) 2 Failing to set yourself apart from other candidates 1 Not asking for the job (at the end of the interview say "I am very interested, and I hope that I am the candidate that you select" "after meeting you, learning more, I am so excited, I hope I get this job")

Physician Phone Call

Physician Phone Call -Short, concise -Why are you calling? ---Update on status ---Report a concern ---Compliment ---Thanks for the referral

So, to assess the quality of your PT practice look at...

[HINT: 6 areas outlined in APTA Standards of Practice] -Ethical/legal -Administration of the practice (mission and goals?) -Pt/client management -Education (we are responsible for our own professional development) -Research -Community responsibility