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Is my job “patient care” or “paper care”?

When I started as a Physical Therapist over 20 years ago, the job seemed simpler. I evaluated and treated patients, wrote very simple notes and spent the vast majority of my day thinking about getting my patients better. Fast forward 20+ years and things have changed quite a bit…now I spend the majority of my day wondering if I am documenting correctly. Did I fill out the right form? What are the requirements of this insurance company? Does this patient have proper authorization? What are the benefit limits for this patient? Although my focus is “patient care”, I can’t help but notice that my job is now mostly “paper care”.

Is all this “paper care” making “patient care” better? I doubt it. I will admit that the notes I write today on patients are much more thorough than what I wrote 20 years ago…so that is a good thing, but all the extra work required by insurance companies isn’t making things better. Essentially my job is to not get denied payment, not commit accidental fraud, not miss a deadline on an authorization and make sure I check off all the correct boxes as opposed to treating patients.

Just the other day I was forwarded an email from a colleague that she had received from a former patient, thanking her for helping him get back to his life again. It was a great letter and a testament to the skill of the therapist who received the letter. I complimented her and commented about how good it feels to get that type of feedback. She responded “that is what it’s all about, right…” to which I responded: “nope…it’s all about the documentation”. At the time I was joking…but was I really?

I understand the need for documentation. I understand that in order to discourage fraud and abuse that each insurance company gets to impart its own version of paperwork and proper coding for their claims…but should it really be taking away from delivering care and actually adding cost to the delivery of care? I don’t think so…

I know primary care MD’s have it much worse than I do as a physical therapist…I can’t imagine spending a day in their shoes. Having 8-10 minutes to evaluate and diagnose a patient, decide a course of treatment and making sure that what you are choosing to do fits into the guidelines imparted by that patient’s insurance coverage. My brain hurts just thinking about it.

I promise that when I am working with a patient, I really am focused on that patient…I just wish it was the only thing I had to think about. The unfortunate part is it is going to get worse, not better.

Michael Vacon, PT
Clinician by choice, paperwork pusher by necessity!