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LEARNING OBJECTIVES
Discuss components, characteristics, and types of contemporary outpatient care.
Analyze key licensing, accreditation, and reimbursement requirements.
Discuss contemporary outpatient practice issues (i.e., referrals, kickbacks, use of the term physical therapy, reimbursement limits).
Analyze the work of physical therapists in outpatient centers.
Determine the managerial roles and challenges to managerial responsibilities.
Analyze managerial decision-making in given outpatient situations.
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Part 1 The Contemporary Setting
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Overview of Outpatient Physical Therapy
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Physical therapy was typically based in hospitals or physicians' offices in the early years of the profession. However, the emergence of nationwide rehabilitation corporations with the inception of the Medicare program in the 1960s and 1970s provided many additional outpatient employment opportunities for physical therapists. The advent of the Medicare program also led to another important outpatient development—private practices owned and managed by physical therapists as reimbursement policies made these opportunities attractive and lucrative.
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Interest in outpatient physical therapy continues today. In 2010, 33.6% of the American Physical Therapy Association (APTA) physical therapist members reported private outpatient or group practices as their place of employment. Others working in healthcare systems may be assigned to outpatient centers.1
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A shift from inpatient to outpatient care at all levels of healthcare also contributes to the self-employment of professionals. The more important factor, however, is that many physical therapists often find caring for outpatients with subacute and chronic musculoskeletal disorders more preferable than caring for patients with more acute, complex conditions found in all other practice settings. Based on a 2010 survey, about 82.6% of patients in outpatient settings receive physical therapy services for musculoskeletal conditions.2 This focus on outpatient care is supported by the fact that more than 16,000 physical therapists belong to the orthopedic section of the APTA,3 and in 2012 the 12,937 APTA-board-certified specialists were overwhelmingly certified in orthopedics (7,655), and sports (1,094).4 Medicare reimbursement policies also skew the patients to those with acute musculoskeletal problems or those who have had orthopedic surgery. People with other diagnoses associated with chronic musculoskeletal or other complex medical conditions are less likely to receive outpatient services because of reimbursement policies. Therapists may also find it more difficult to develop goals for patients with chronic conditions if their potential for improvement is limited. These complex patients also tend to be sicker, which makes it more difficult for them to make their way to an outpatient center on a regular basis.
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Licensure, Certification, Regulation, and Accreditation
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Regardless of the type of center, all outpatient physical therapy providers must be certified as individuals or as a group practice to be reimbursed for their services. Provider organizations are certified by agencies in each state to be either rehabilitation agencies or certified outpatient rehabilitation facilities (CORFs). These certification processes are complex. Simply stated, the difference between the two types ...