Integrating the Resident into Private Practice Wendy Beattie, CPO

Why we have residents n We learn from them n New people to the profession are more likely to assimilate into our vision of practice n They keep us sharp

There’s a lot to learn

Demonstrate n Evaluation n Procedures n Patient Education n Notes n Follow up n Billing

Next, direct continuous supervision Joint evaluation, with discussion, in the room with the patient or afterwards Resident does Patient Education with practitioner filling in missed points Resident writes notes. (Practitioner reviews notes, writes supplemental notes, cosigns)

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

Follow-up Treatment Plan and Practice Management

Follow Up Treatment Plan

“Solicit subjective feedback from patient” Use quotes in chart notes

Charting Functional Level, and Medical Necessity n E.g.,Patient walked on uneven ground, walked at various walking speeds, etc. n Patient required custom shoes because of deformity of foot. n Shoe was required for proper function of the orthosis. n All of these must be in the patient notes

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

Reassess patient knowledge and understanding of goals and objectives n Does the patient remember instructions? n Are the patient’s goals and objectives the same as the resident’s?

Document all findings and actions and communi- cate with appropriate healthcare professionals n Charting skills n Copy all letters relating to the patient n Chart all telephone conversations n Chart all missed or cancelled appointments

Develop long-term follow up plan n Discuss diagnoses n Patient Reliability n Routine Maintenance n Not generally covered in school

Practice Management n Demonstrate Proper Documentation of Patient History and Financial Records

Policies and Procedures regarding: n Human resource management n Business/finance management n Organizational management

Insurance verification of benefits n Residents must call and obtain benefits verification/authorization for a variety of insurances n Teaches appreciation of front office staff, of complexity and time involved.

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

Learning to Educate : The patient, on their coverage The insurance company, on value of service, on patient needs Referral Sources, on coverage, including “generic equivalents”

Billing n Discuss philosophy of L codes n Difference between coding and pricing n Understanding, HMOs, Medicare, Medicaid and our policies with each

Medicare n Guidelines n Policies concerning Hospitals n Rules regarding Skilled Nursing Facilities n Part A vs. Part B

Running a business n Cost vs. reimbursement n Understanding the difference between item cost and cost of delivering the service n Setting prices for NOC items

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

Manufacturer’s recommended coding Resident must feel codes are appropriate, despite recommendations

Marketing n Contact with Physicians n Therapists n Letter writing skills

Read and Follow Manufacturer’s Guidelines

To determine need for changes relative to initial treatment goals n Is the fit appropriate? n Formulating plan for necessary modifications n Making necessary adjustments without compromising function n Think before you act

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

Being an effective Resident Supervisor n Make sure personalities mesh. n Ask questions and encourage the resident to ask them as well. n We want the resident to succeed, to not only pass the exams, but to become a clinician able to practice on their own.

The Key to Success Get the right resident…