Some of you may have read my previous blog post and worried yourself sick over the future of PTs in the US. Some of you are students, some are professionals on the path to achieving their US license and some are already PTs in diaspora scattered throughout the US. Now, after reading my last blog entry, a little hope might have died on you or you may have lost a little faith in yourself and in your future as a therapist in this country. This blog entry I am now writing, is intended to restore whatever was lost in you and make you dream big again.
Once more, I am no expert in Medicare as well as in the many different practices of healthcare in general and physical therapy in particular. Therefore, I would very much welcome all statements and comments from other US PTs in our community to help clarify the real goings-on in our practice.
The thing I want all of you to engrave in all of your being is that there is a need for PTs in the US. There is a need because the baby boomer population is getting older and they would need therapy eventually. There is a need because PT programs here reach a staggering seven-year curriculum to get a DPT. Education is very expensive in the US. Unlike in the Philippines where it is considered the parents' responsibility to send their kids through university, here people work to get themselves an education. A whole seven years to spend schooling is seven years of maintaining high grade point averages while working at least one job on the side. Most people would have a hard time coping with such a schedule. Thus, fewer Americans are taking up physical therapy as a career and as older American PTs go to eventual retirement, they would need replacements and even more PTs to keep up with the demand from baby boomers. Most likely, they would hire Indian and Filipino PTs because of our good command of English and very close resemblance of our PT school programs to theirs.
Now I did mention of Medicare going bankrupt and the Manual Medicare Review being a pain in the ass in my last entry. It is largely out of frustration that I blurted that one out. Though the fact remains that Medicare may run out of money if drastic reform is not undertaken to curtail unnecessary expense and fraud, I am hopeful that the reforms they will apply are reasonable and can be worked with. The Manual Medicare Review (MMR) will eventually become more organized and efficient and will be streamlined with private insurance company procedures. Now, private insurance companies may be stingy with the amount of treatment they would be paying for the patient (like allowing only 10 treatment days instead of the fifteen days you would request to work with a patient) and are also very demanding with paperwork, private insurance companies are efficient in their delivery of benefits. It is like you contact them regarding a patient under their insurance policy, send them the necessary paperworks including your prognosis and expected outcomes for the patient, you would usually receive a reply from them within the next two days. MMR, on the other hand, would take a month to process everything and send out a reply to you. However, once the MMR system becomes more organized, delivery of services and reimbursements will be faster and more efficient.
I would also like to clarify that the mess that MMR has gotten us into, so far has no effect on Medicare A patients. Medicare A covers hospital care and that means PTs working in acute care rehab (hospital in-patient) and skilled nursing facilities (sub-acute care) are not affected. MMR affects outpatient services under Medicare B which includes homehealth therapy, outpatient rehab and long-term care such as nursing facilities. (Take note that a skilled nursing facility is different from a nursing facility. A nursing facility is basically a nursing home, a retirement home for the elderly where the patients are usually long-term whereas a skilled nursing facility is more of sub-acute care. Patients in SNFs are usually short-term; they are those that don't really require very close medical monitoring but are not yet healthy enough to go back home. It is not unusual that a nursing facility may have several skilled bed units or a skilled nursing facility have some long term care residents). The new Medicare changes will have the MMR process continued for this year, so hopefully those running the system start getting the hang of it and get things done faster. To cap it all, life goes on easy for PTs working in SNFs and hospitals but PTs working in nursing homes, home health and outpatient facilities will have to make necessary adjustments.
Another point I would like to stress out is that the demand for PTs continue to be really high in many parts of the US. We probably never hear of them because almost all of our peers are concentrated on the Eastern and Western seaboards. Almost everyone is in NY, NJ, California, Florida, Illinois, Maryland, Washington and Texas. These become supersaturated with PTs that it seems you won't be able to find another place to work at if you move. However, if you think about many other mid-Western states and other states without the very large metropolises, this is where PTs are needed most. Think New Mexico, Arizona, Alabama, North Dakota, Oklahoma, South Dakota, Ohio, Oregon, Missouri, Iowa, North Carolina, Tennessee, South Carolina, Louisiana and Mississippi. In these places where it is less flashy and more quiet, you can get the most out of your money. I live in Northern Virginia, about thirty minutes from Washington DC, and I pay fourteen hundred for a two-bedroom apartment. My friend in New Mexico pays five hundred for a three bedroom house with a fenced yard. I get paid slightly higher than her but with the cost of living here, she gets a whoooole lot more for her money. Try living in New York and your wallet would hurt more. True, you probably would have to drive at least two hours (or maybe five) to get to something exciting over there in New Mexico. And true, Washington DC is but a half-hour drive for me. But the fact remains: How many times do you really need to see the White House and get your picture taken before you're satisfied? Even in a big city like New York, you won't even be able to enjoy exploring it if you are working hard five times a week. At the end of the day, it is best to pick a place where you have a good work-life balance. And another tip, if it is possible, don't pick a state where there are a lot of Filipinos. You'd be free from all the drama and pataasan-ng-ihi events. It is best to pick a state where Filipinos are afew and therefore are a much tightly-knit and closer community. You'd thank me later.
Finally, my friends, our best defense against evolving Medicare regulations is to hone our ability to perform a very necessary but seldom emphasized skill in the clinic: documentation. In the Philippines, we take for granted writing notes because 1.) we directly communicate with a patient's family and his doctor regarding his progress and 2.) we copy/paste our notes for almost all our patients involved (e.g. PT Note dated today: Pt was seen with the same management as so-and-so date. Pt tolerated tx without untoward incidents.) We write this PT note for all our patients sa Pinas. This is way different how we do things here. Our notes are more detailed and functional progress (or regress) should be stated clearly and in a meaningful, complete but concise detail. In order for you to be able to do that, first of all you should be keen in your observation and evaluation of your patients. I mean, how can you write a good, accurate and scientific PT document, if you don't even know what to observe in a patient in the first place, or what questions to ask the patient in an interview or if what a patient is explaining to you may even be relevant in your note-writing?
Your clinical decision-making skill will be called upon if you want to keep a steady caseload. It is very important to know how to screen patients who are appropriate to be picked up by physical therapy. Take note that I used the term "appropriate" instead of "need". Not all patients who need therapy are appropriate to be picked up by physical therapy. It is you who make a clinical determination of that. Remember that the appropriateness of giving skilled physical therapy services is among the factors that will ultimately determine denial or approval of MMR. Modesty aside, since October to early December 2012, from among the fifteen or twenty patients that I have sent out for MMR, I only had one denial. That denial was based on technicality (wrong Medicare number or something) so that isn't my fault. The reason for my success with the MMR process is simple: proper and complete documentation. I am not saying my notes are perfect, but they are definitely suffice to the standards set by Medicare.
As I conclude this blog entry, let me leave you with some advice. 1.) Don't worry about the future of PTs in the US; we have a good future here. We are skilled professionals. People will get old, people will have fractures, people will get sick. There will always be a need for us. Worry ka ng worry sa future mo hindi mo nga mapasa-pasa yang lintek na TOEFL na yan. Focus on the present first and later on decide to cross the bridge when you get there. 2.) Despite the rumors (or urban legend :-D ) that documentation is really hard, the truth is, it is only hard in the beginning. Once you get the hang of it, it will just flow more easily from you. 3.) Learn to drive. Unless you want to live in NYC where you can get anywhere with trains, anywhere else you would need to be able to drive around. So before you leave the Philippines, take some driving lessons (with an automatic transmission car); it will make your life way easier and acculturation way faster. 4.) If your main goal of going to the US is just to earn money, you will never be happy here. Better stay in the Philippines with your loved ones than come here and hate your job and situation. To be satisfied with your lot in life as an expat PT, come here to LEARN first, and to EARN second. Money is not the end-all and be-all of your life as a PT. Happy New Year to all and I hope nabuhayan ng kahit konti ang mga pangarap ninyo.
P.S. I would very much appreciate comments and additional information that you guys would like to add to paint a more complete picture of our experiences here. Let us work hand in hand to ensure that more PTs will discover their true calling as extensions of God's healing hands.
P.P.S For the grammar Nazis, my apologies. Tao lang po.
Finally, my friends, our best defense against evolving Medicare regulations is to hone our ability to perform a very necessary but seldom emphasized skill in the clinic: documentation. In the Philippines, we take for granted writing notes because 1.) we directly communicate with a patient's family and his doctor regarding his progress and 2.) we copy/paste our notes for almost all our patients involved (e.g. PT Note dated today: Pt was seen with the same management as so-and-so date. Pt tolerated tx without untoward incidents.) We write this PT note for all our patients sa Pinas. This is way different how we do things here. Our notes are more detailed and functional progress (or regress) should be stated clearly and in a meaningful, complete but concise detail. In order for you to be able to do that, first of all you should be keen in your observation and evaluation of your patients. I mean, how can you write a good, accurate and scientific PT document, if you don't even know what to observe in a patient in the first place, or what questions to ask the patient in an interview or if what a patient is explaining to you may even be relevant in your note-writing?
Your clinical decision-making skill will be called upon if you want to keep a steady caseload. It is very important to know how to screen patients who are appropriate to be picked up by physical therapy. Take note that I used the term "appropriate" instead of "need". Not all patients who need therapy are appropriate to be picked up by physical therapy. It is you who make a clinical determination of that. Remember that the appropriateness of giving skilled physical therapy services is among the factors that will ultimately determine denial or approval of MMR. Modesty aside, since October to early December 2012, from among the fifteen or twenty patients that I have sent out for MMR, I only had one denial. That denial was based on technicality (wrong Medicare number or something) so that isn't my fault. The reason for my success with the MMR process is simple: proper and complete documentation. I am not saying my notes are perfect, but they are definitely suffice to the standards set by Medicare.
As I conclude this blog entry, let me leave you with some advice. 1.) Don't worry about the future of PTs in the US; we have a good future here. We are skilled professionals. People will get old, people will have fractures, people will get sick. There will always be a need for us. Worry ka ng worry sa future mo hindi mo nga mapasa-pasa yang lintek na TOEFL na yan. Focus on the present first and later on decide to cross the bridge when you get there. 2.) Despite the rumors (or urban legend :-D ) that documentation is really hard, the truth is, it is only hard in the beginning. Once you get the hang of it, it will just flow more easily from you. 3.) Learn to drive. Unless you want to live in NYC where you can get anywhere with trains, anywhere else you would need to be able to drive around. So before you leave the Philippines, take some driving lessons (with an automatic transmission car); it will make your life way easier and acculturation way faster. 4.) If your main goal of going to the US is just to earn money, you will never be happy here. Better stay in the Philippines with your loved ones than come here and hate your job and situation. To be satisfied with your lot in life as an expat PT, come here to LEARN first, and to EARN second. Money is not the end-all and be-all of your life as a PT. Happy New Year to all and I hope nabuhayan ng kahit konti ang mga pangarap ninyo.
P.S. I would very much appreciate comments and additional information that you guys would like to add to paint a more complete picture of our experiences here. Let us work hand in hand to ensure that more PTs will discover their true calling as extensions of God's healing hands.
P.P.S For the grammar Nazis, my apologies. Tao lang po.
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