Bulletproof Physical Therapy Decisions
Decision making tools and techniques for physical therapists


 Tools for the Bulletproof Physical Therapist
 Clinical Practice Guidelines with Evidence Based Tests and Measures for Knee, Hip, Heel and Neck Pain
 OPTIMAL patient self-report scale - get baseline values to show progress.
 World Health Organization International Classification of Functioning (ICF) - make diagnoses like physicians.
 Physical Therapy Diagnosis - a quantitative approach
 OIG Compliance Program - what you need to know - and do!


Medicare's Mission
What does Medicare want from Physical Therapists?  Not much - just good value for their money: 

"The goal of Medicare payment policy is to get good value for the program’s expenditures, which means maintaining beneficiaries’ access to high-quality services while encouraging efficient use of resources. 
Anything less does not serve the interests of the taxpayers and beneficiaries who finance Medicare through their taxes and premiums." 

I hope I can serve Physical therapists and my nation's health payers by showing that process measures and procedure-based narratives are the least efficient use of their physical therapy resources.

Have you seen the new 17-page Medicare Evaluation form for Outpatient Physical Therapy?
  • Are you ready to include this monster document in your clinical workflow?
  • How will you get paid for your time filling it out?
  • Will it improve your outcomes?
  • If you have concerns or wish to add your input to the discussion then now is the time to get involved.


How can Bulletproof Physical Therapists' Decisions help you?

Do you want to learn to use evidence based physical therapy templates and workflows for your Medicare compliance program?

You will be more productive.  You will have better outcomes.  You will use evidence based techniques to improve your documentation. You will be able to write your work easier and quicker. Your notes will have more VALUE.

Right now, Medicare audits your notes using Process Measures, that is:
  1. the 8-minute rule
  2. the -kx modifier
  3. 'skilled therapy' (as determined by an 'expert' auditor)
  4. time-in & time-out
  5. PTA supervision requirements based on treatment setting
  6. Minimal Documentation Requirements
  7. 'one-on-one' codes
  8. physician certification of the physical therapy plan of care
  9. et al


"The elephant in the room..."

Nobody wants to talk about this but NOT ONE of these process measures improves outcomes or reduces costs (except the -kx modifier) - these are 'proxies for value' in a healthcare system that tracks procedure codes better than it tracks individual patient outcomes.

You can show your VALUE using currently existing Outcome Measures that will dramatically change the way you work, the way you write your notes and how much better your patients will get - they will get better that they ever have before!

You will...

  1. reduce your paperwork
  2. reduce your notewriting
  3. reduce your denial rate
  4. reduce your audit liability
  5. increase your face time with patients
  6. increase your enjoyment of your job
  7. increase your income and reimbursement

Doctors make decisions using probability and evidence.  Physical therapists can too... 

Tools now exists that were not in widespread use when the current system of Medicare audits, RAC audits and the current system of mandated Medicare process measures were implemented 20 years ago.

Medicare requires Medical Necessity, Skilled Care and Progress.  All of these critical areas of Medicare compliance are now demonstrated by evidence-based physical therapy tools and techniques.

Bulletproof shows you how.

Bulletproof physical therapy decisions use baseline and follow-up measures to show progress, medical necessity and skilled care.

We recommend a disablement model to frame your clinical thought process.  Avoid the medical/pathology model of treatment planning and clinical decision making.  You are not a physician - but you could be a doctor.

You need to select standardized performance measures or impairment measures.  

You can also go 'all the way' and use treatment based classification (TBC) to improve your physical therapy predictions.  TBC is the 'icing on the cake' of skilled physical therapy decision making.

I recommend published clinical practice guidelines (CPGs) that have compiled many of these tests and measures for you. 

Everything required for a Bulletproof note is independently authenticated, updated and evidence-based.

Stay abreast of changes in these relatively long-lived instruments and you will have a continually updated compliance plan.

No more... 

...will your compliance plan sit dusty on a shelf in your office making you feel guilty when you drive home at 8pm , and think to yourself …

“I should really stay at the office and update my Medicare compliance plan before I get audited”

Updating your three-ring binder in your office that says “Medicare” on the front is unsatisfying since you have no way to know the job is done.

So, you go to Medicare continuing education courses to find out how to do it.

You may spend eight hours on a Saturday learning about ‘re-certification requirements’ to update your manual and next month Medicare changes the requirements.

You may loose sleep thinking about mortgaging your home from an unfavorable Medicare audit.

You may wistfully think back to your days in physical therapy school when you dreamed private practice was about good patient care.

You may have dreamed and done all this, like me.

Now, you can live the dream.

The dream is treating your patients, getting them better and getting paid an honest day’s wage for an honest day’s work.

No more sleepless nights.

No more dusty three-ring binders.

But first, you need to have a baseline measure (52% of the physical therapists in the USA don't).

Get one and get started.

See how Bulletproof is better.

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