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Putting Pen to Paper Should be Paid by Carole Lewis, PT, DPT, PhD, FAPTA and Linda McAllister, PT, DPT The field of law would fall apart if those professionals were not paid for their time to document what they are doing: researching and analyzing. Why are physicians, therapists and others in the medical field being denied payment for the same professional services? If you would ask a payer, you would get an answer that says the charge is inclusive of the time to document the activity. But is it? I know in the physical therapy profession, billing codes are designed and strictly monitored for the time spent face-to-face with the patient. If that is the case, how can the documentation time be included under these codes? While point-of-service documentation may have some merits, writing a thoughtful analysis and plan is hardly feasible while giving needed focus to our patients. And we do not want therapists sitting in front of patients documenting instead of providing the care, do we? So much time and lip service has been given recently to burnout and fear of too much pressure on those in the medical fields. The medical literature even analogizes physicians to “Canaries in the Healthcare Coal Mine”.1 According to Talbot and Dean in this article, physicians are not burnt out but suffering from moral injury because of the broken health care system. The suggestions for improving this are to have these fried professionals take an hour to meditate.2 This won’t fix the problem; this study shows that meditation may help the symptoms, but the symptoms come from the frustration of not being valued for what we do. Lawyers document and get paid for every second they spend of a case. Why don’t we? Let me tell you a sad but common scenario. One of my faculty was telling me about his night in bed with his wife. (Do not worry, this is not going where you think it might.) He said in the evenings, he and his wife are in bed and his wife sits on her laptop catching up on shows and he spends hours keeping up with his documentation. This is the life of many of us in medicine and it is wrong. We need to be paid for what we document. We need codes to do this separately from the codes for the procedures. This will allow the medical team to be valued for what they do and the process of diligently recording their findings. Payers do not want an undervalued workforce or one that is burned out from the injustices of the health care system. Many of us accept this extra burden as “part of the job” and contribute documentation time off the clock to keep to our productivity standard. We, as health care providers, need to educate the payers on the current situation and try to fix it instead of continuing to take the hit in our private lives. Our column is usually about clinical issues — this is
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a particularly important clinical issue. This is a rough time right now to be asking for more payment but are we really asking for more or just to be paid appropriately? We do bring so much to the health care table that no other discipline can. The system needs to be redesigned and those redesigning need to take this into the models for future care. Take the time to write to CMS, payers, and stakeholders and ask for additional codes for documentation time or, even better, a better system. References 1. Talbot S, Dean W. (2018). Physicians aren’t ‘burning out.’ They’re suffering moral injury. The Boston Globe. https://www.statnews. com/2018/07/26/physicians-not-burning-out-they-are-sufferingmoral-injury/. Published April 14,2009. Accessed September 28, 2020. 2. Thimmapuran J., Pargament R, Sibliss K, et al. Effect of heartfulness meditation on burnout, emotional wellness and telomere length in health care professionals, J Community Hosp Intern Med Perspect 2017; 7:1;21-27.
Carole Lewis, PT, DPT, GCS, GTCCS, MPA, MSG, PhD, FSOAE, FAPTA, is the President of and faculty for GREAT Seminars and Books and Great Seminars Online (www.greatseminarsandbooks.com and www.greatseminarsonline.com). She has her own private practice in Washington DC. She is Editor-in-Chief of Topics in Geriatric Rehabilitation and an adjunct professor in George Washington University’s College of Medicine. Linda McAllister, PT, DPT, GCS, GTCCS, CEAGN is a board-certified Geriatric Specialist and lecturer with Great Seminars and Books. She currently practices in home health with EvergreenHealth in Kirkland, WA. She is an adjunct faculty member of Arcadia University and serves as coordinator for the Geriatric Training Certification with the Geriatric Rehabilitation Education Institute.
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