MDT Bulletin of The McKenzie Institute Americas Region

With ever increasing cuts in reimbursement, we have to prove that our service is medically necessary and functionally significant through documentation. Physical Therapy is under ever increasing scrutiny by the insurance industry to justify our services and explain the functional importance through documentation.

In MDT, we have the added challenge of providing a service that has many variances in the way it is applied. Many therapists use it as a "tool" when they miss its power as the "toolbox". By using MDT as a clinical reasoning tool, the documentation is an effective way to communicate a process that requires advanced problem solving. This is achieved by continuous reassessment to support classification for determining prognosis: the strongest selling point for the MDT method to payers.

One of our biggest challenges is educating payers as to what MDT is, and how it differs from other types of physical therapy. The only way we can effectively demonstrate this is through our documentation, which must be easy to understand. Payers do not know the person you are treating, and they have no way of knowing if you are being effective, unless you tell them. Reviewers may or may not have a PT background. Therefore, your job is to make your notes read like a story, so anyone reading them can see your logic and follow through. This is where MDT clinicians can shine, because when done correctly, the MDT process is very simple and logical.

The following suggestions can help payers better understand the MDT method.

Subjective: Tell the story of your patients by summarizing the history portion of the MDT assessment form. Paint a picture that will answer the following questions:

Objective: Document in a manner consistent with the McKenzie Institute and be sure to use functional baselines, whenever possible, during the repeated movement portion of the exam. Your argument will be much more powerful if the patient reports a change in function.

Avoid using abbreviations unless you have previously defined the term in that note. RFIL, REIL and P, W are not universally understood terms, so you must spell them out. It may take some extra time while writing the note, but it will save time and money in returned claims.

Assessment: Provides a logical conclusion from a combination of the subjective and objective. Remember, your job is to make a decision:

Plan: The plan should be an extension of the assessment - clearly stating classification, duration and treatment, and how treating this problem should affect their functional limitations.

Choose only one intervention, so that you are able to objectively assess the effects of the intervention. Avoid the urge to treat before you have a classification, which McKenzie is careful to point out could take several visits. If you haven't confirmed classification in 3-5 visits, refer back to the physician: this is the best selling point to the payers; so that you can demonstrate you will not overtreat.

Each note that follows should be a mini-assessment, with emphasis on function. Ask your patient to report a percentage improvement every two weeks and assess their functional goals. Set a point of progress, i.e. 50%, and make adjustments as necessary. If the patient plateaus, it may be a sign that you either need another set of eyes, or they need to be discharged.

Meeting with the payers
If you have a relationship with a payer, start by having a conversation and explain that you want them to understand the MDT method.

In order to translate MDT to payers, we have to make sure, first of all, that we understand their needs. Payers want to save money. No matter where you go with the conversation, remember that the key for them is being able to provide the service their customers need at the lowest cost available. There are a couple of ways to achieve this goal by using a MDT provider:

In this meeting, discuss the reliability of the method in comparison to passive treatments. Educate the payer on the importance of classification and centralization. Finally, support your conversation with research.

Remember, the care provided with a skilled MDT clinician starts with the thought process; to figure out the most effective way to take care of the patient. We are the movement experts, and it is our logical assessment of a musculoskeletal complaint that will help this person and get them back to life.