Washington University Program in Physical Therapy Organizational and Management Issues Spring 2014 PT 651 Crowner Course Description 3 credits 44 lecture hours Faculty This course is designed to prepare students for managerial and administrative situations that they will face in their first jobs as physical therapists. The course will view management issues from a macroscopic to a microscopic perspective. Students will first learn about the health care environment today and the delivery of health care within contemporary systems of organizations. They will then learn about the dynamics of organizations, which will affect them and continue to develop their skills for working with people within those organizations. Students will gain insight into the external and internal pressures organizations face and understand their role in working for an organization. Their knowledge about the roles of the physical therapists and the laws that direct practice will be expanded and they will develop their skills for working on a team. Students will gain an understanding of the managed care environment and be prepared to balance quality care with financial responsibility at their future employment settings. Current physical therapy practice issues will be addressed. Students are expected to integrate and expand on previously learned information on ethics, law, and skills for negotiating for change into the activities required in this course. Teaching methods for this course will include lecture, discussion, and active participation with in-class group activities and case studies. One group assignment, three individual assignments, a midterm and a final exam will be given. Course Master: Lecturers: Beth Crowner PT, DPT, MPPA, NCS Office: 286.1416 Home: 618.394.9920 crownerb@wustl.edu Damon Braggs MBA Emily Crownover PhD Ron Gribbins PhD Hilary Harris PT, MS Donna Heroux Ann Plunkett Rosalie Schreckenberg 1
Goals By the end of the course students will: 1. understand the issues affecting health care delivery systems today and appreciate the changes in health care delivery as physical therapy has evolved. 2. understand how structure, diversity, leadership, management style, and communication patterns affect an organization and the people within that organization. 3. comprehend how balancing quality care with financial responsibility is necessary in today s health care environment, especially in the era of managed care. 4. be prepared to function in an entry-level physical therapist position practice with skill in minimal risk, providing precise documentation, and measuring various outcomes of practice. 5. expand skills needed for seeking and obtaining their first job as a physical therapist. 6. have elementary skill is using consultants, providing consultation, and demonstrating entrepreneurial characteristics. 7. understand how medical ethics across disciplines affects decision making and treatment in physical therapy. 8. understand political and bureaucratic structures in which health care policy is formulated and through which it is implemented. 9. understand the opportunities for and limitations on healthcare leaders involvement in political and policy-making processes. 10. understand legal and policy guidelines for human resources as they pertain to hiring, managing, and terminating employees. 11. understand factors that affect staff/departmental productivity. 12. understand how reimbursement changes affect the ability to directly assess the relationship between productivity and the ability to be profitable. 13. understand how public relations and marketing can enhance visibility and access to a clinic. 14. have elementary skill in creating a mock business plan. 15. understand selected theories of management style and principles 2
Objectives By the end of the course, students will be able to: 1. work actively and cooperatively in small groups/teams to make decisions and complete projects of varying size. 2. assume the role of team leader for at least one group activity. 3. communicate with others in health care about management issues, demonstrating proficiency with common terms and acronyms defined in the readings. 4. use case study questions in the text to apply practical information from the text and lectures to case scenarios. 5. describe the health care delivery system by types of care and setting. 6. summarize American health care social philosophy and public policy changes that have occurred in the past eighty years. 7. identify external sources of influence on health care including government regulations, CMS, OIG, JCAHO, and CARF and recognize how they affect PT services. 8. describe changes that have occurred in health care in response to changes in social philosophy and public policy in the past 30 years (people and organizations). 9. describe how their values and the values of others influence behavior in the work setting using concepts from values theory and motivation theory presented in class. 10. refer to and abide by the APTA code of ethics and Guide for Professional Conduct to demonstrate consistent professional behavior in class and in the clinic. 11. recognize factors that influence management style and characteristics about yourselves that will influence your response to managers and, later, your own personal style of managing. 12. use the Conflict Partnership Process to resolve conflicts that may arise in your work team. 13. characterize business structures by their legal structure, tax status, and operating structure. 16. define and provide examples of work design parameters. 17. recognize influences on employee retention and turnover and suggest management actions that encourage retention. 18. identify specific laws regarding overtime, breaks, and pay (exempt versus non-exempt employees) that apply to individuals at various staff levels who may be working in a P.T. department. 19. use a model for delegating to extenders to make appropriate decisions about roles assumed by individuals in a P.T. department and to enhance efficiency in specific scenarios provided in class. 20. use effective communication to resolve conflict or effect a change in behavior of another health care professional in a role-playing situation. 3
21. appreciate the importance of being financially responsible as a physical therapist within any organization. 22. define basic accounting principles including entity, transaction; cost valuation; double entry, accrual. 23. identify concepts of general accounting conventions. 24. define terms associated with financial statements including balance sheets, assets, liabilities, equity, revenue, net and gross income, expenses, and cash flow statements. 25. create financial statements for a mock physical therapy practice including: a break-even analysis, pro-forma balance sheet, pro-forma income statement, pro-forma statement of cash flow. 26. describe a fee schedule and appreciate the importance of knowing the fees being charged to patients. 27. discuss the impact of case mix, payer mix, charge and payment methodology on the operating revenue of a department or organization. 28. define the types of operating and capital expenses that departments must manage. 29. classify an expense as either fixed, variable, or semi-variable costs, given examples from a case scenario. 30. demonstrate a working knowledge of analyzing cost-volume-profit relationships to appreciate the importance of the break-even point. 31. show the relationships among financial management planning, annual budget planning; performance reporting, and performance variance analysis in the financial planning process. 32. describe methods to monitor financial performance, including measurement of quality control, outcome assessment and performance improvement. 33. describe the risk involved with various methods of payment cost-based, fee for service; per diem; case rate, capitation. 34. list the sources of payment for health care services who is eligible to be served by these sources, and what is covered by each (patients/families, health care providers, charity, employers, indemnity health insurance, managed insurance, Medicare and Medicaid). 35. recognize how to maximize income within a P.T. department and the effects on quality of care. 36. describe policies and procedures, which, if followed, will enhance receiving payment for services. 37. appreciate the amount and variety of information contained within a clinical system (private practice or organization-based clinical services) and describe how typical information systems work in specific situations. 38. compare different performance indicators and choose those that would be relevant for given scenarios. 39. use a systematic approach to develop outcome measures of clinical performance; financial performance and customer satisfaction. 4
40. assess the data collected from a quality improvement (QI) project and design an instrument for measurement across sites in acute care, outpatient orthopedics, or neuro rehab/pediatrics. 41. describe processes necessary to obtain insurance contracts and National Provider Identifier (NPI) numbers. 42. provide examples of abuse, assault, harassment, and misconduct and describe policies, procedures, or laws that protect individuals from these incidents. 43. analyze traditional management theories in the context of job satisfaction. 44. describe the components of a business plan and their uses. describe the functions of a Human Resources department in hiring, firing, and job performance evaluation. 45. describe the political environmental factors that affect how public policy regarding healthcare is made. 46. demonstrate basic skills for analyzing policy issues and applying them to healthcare operations. 47. recognize the philosophical, social, economic, and scientific forces that shape the process of health policy formation. 48. define (historically) productivity and describe/list factors that affect productivity of an individual or department. 49. identify methods through which a marketing plan can be developed. 50. list characteristics of good public relations. 51. describe selected theories of management style (traditional, human relations, human resources, and contingency models) and evaluate the forces on a manager that influence choice of management style. 52. describe common methods of coordinating work and give examples in a physical therapy context. 53. describe and perform the process of implementing an idea bounce to market an idea for a clinical practice or program. 54. describe the purpose and processes regarding participation and compliance with CMS s Physician Quality Reporting System and Functional Reporting policies. 55. Understand the transition from ICD-9 to ICD-10 diagnosis coding and how it will affect billing and coding for physical therapy. Course Schedule: The course is scheduled on Wednesdays from and Thursdays from, with exceptions noted on the course schedule. Readings: Refer to schedule; These refer to your recommended textbook (Nosse, et al.). Additional required readings in the form of handouts and articles will be provided by the guest lecturers. Required Textbooks None 5
Recommended (in the future for clinical experiences) 2002 Coding and Payment Guide for the Physical Therapist, An Essential Coding, Billing and Reimbursement Resource for the Physical Therapist, Ninth Edition, APTA and St. Anthony Publishing/Medicode Publications. (This book is expensive! Convince your clinics to purchase for the department.) Esterson SH. Starting and Managing Your Own Physical Therapy Practice. Jones and Bartlett: Sudbury, MA. 2005. Nosse LJ and Friberg DG. Managerial and Supervisory Principles for Physical Therapists. 3rd d edition. Lippincott, Williams & Wilkins: Baltimore, MD. 2010. APTA website re: reimbursement: Home- Practice Management-Payment by Treatment Setting Assignments: Reimbursement and Productivity Assignment (was due 12/2/13) The purpose of this assignment is for students to understand the language of reimbursement and the issues (ethical, legal, and practical) associated with establishing and maintaining appropriate productivity standards. Students are required to make an appointment and interview the owner or manager of the clinic/department during CE III and IV and complete a survey/questionnaire that was provided to them by the course master. Quality Improvement Individual Assignment (was due 12/2/13) The purpose of this assignment is to gain experience and knowledge related to the planning and implementation of a quality improvement (QI) project in the clinical environment. Students will incorporate information they learned related to QI that they received in Professional Issues and Skills Development I and III. Prior to beginning CE III and CE IV, students were given choices of projects to be completed while on their clinical education experiences. Students could choose from any of three provided projects in an acute care setting, outpatient musculoskeletal clinic, or adult neurologic rehabilitation or pediatric setting. Students were required to complete a 2-5 page paper addressing the following: 1) Purpose of the QI project (description of relevance to practice in that setting) 2) Description of the project and how/why data was collected in its chosen form 3) Data collected and analysis of the data 4) Description of the strengths/weaknesses of the design, and suggestions for improvement of this project or future related projects. 5) Discussion of how the findings correlate to quality of care and possible solutions or suggestions for change for the site (if indicated). 6
Policy Assignment: Students will be provided several examples of state or federal policies. Students may choose from these examples or use one in which they have particular interest. The purpose of this assignment is for the student to analyze the strengths and weaknesses of the policy, identify stakeholders in the policy, and assess the impact that the policy will have on the stakeholders. Students will be expected to write a 2-5 page paper (double spaced, size 12 font) addressing these issues. This is due by 5:00 pm on February 5, 2014. This assignment should be posted in Sharepoint. Mock Business Plan: Students will sign up/self-select their working goups. The purpose of this project is to incorporate knowledge from the course to develop a business plan for a new outpatient physical therapy practice. Each group will create a mock business plan that will include the following: introductory page, executive summary, description of the venture, production plan, marketing plan, organizational plan, assessment of risk, and a financial plan. This is due by 5:00 pm on March 31 2014. This assignment should be turned in to Beth Crowner s mailbox. Students will also be required to give a group presentation of their plan. The quality of the presentation will be incorporated into the final grade of the mock business plan. Exams Midterm Exam: this exam will cover written and lecture material covered from the beginning of the course up to the date of the exam. The course objectives will aid the student in prioritizing content. This exam will be on February 27th. Final Exam: this exam will cover written and lecture material covered from the midterm exam to the final exam. The course objectives will aid the student in prioritizing content. The date of this exam is to be determined. Grading Criteria: % of Grade Date Completed Quality Improvement Assignment 15% 12/2/13 Reimbursement and Productivity Assignment 10% 12/2/13 Policy Assignment 15% 2/5/14 Midterm Exam 20% 2/27/14 Mock Business Plan 20% 3/31/14 Final Exam 20% To be determined ***Note: Assignments turned in later than the stated due date will receive a 5% grade reduction per day from the original score. 7
Course Schedule: With the exceptions noted below, class will meet Wednesdays from 8-9 and Thursdays Date Topic Lecturer Reading Mon. 1/6 2:30-4:30 Course Overview; Health Policy-social and ideological history, mechanisms of policy formation, and political context of healthcare Chapters 1,2 1/8 1/9 1/15 1/16 1/22 1/23 1/29 1/30 2/5 2/6 2/12 2/13 2/19 delivery Evolution of health care policy, public policy Chapters 1, 2 No Class Performance leadership management-theories and styles of practice Motivation in current healthcare systems- Leadership RG Ch. 28, 29 RG Ch. 8, 10, 14, 15 Values, Motivation in current healthcare systems RG Ch. 8, 10, 14, 15 Health Care Economics, Accounting, Financial Reporting Health Care Economics, Accounting, Financial Reporting Health Care Economics, Accounting, Financial Reporting No Class-CSM No Class-CSM Development of a Business Plan DB Chapters 20, 21 DB Chapters 20, 21 DB Chapters 20, 21 Staffing Patterns; Staff performance/productivity Ch. 21, pp. 421, 22 Human Resources-Managing the Interview HH 8
2/20 2/26 2/27 3/12 3/13 3/19 Organizational Structure-working in teams, networks Chapter 6 Organizing and Engaging People in the Workplace Chapter 14 Midterm Exam PR/marketing for a private practice Chapters 18,19 Types of care, settings, social philosophies; Effects of Technology and Generational Differences in Health Care No Class Chapters 1,2 3/20 3/26 3/27 4/2 4/3 4/9 4/10 4/16 Public Relations and Marketing Employee Appraisal, Recognition, and Corrective Action Innovation in Business and Health Care Selecting, Developing, and Retaining Staff Obtaining insurance contracts and provider numbers and CMS Physician Quality Reporting System Functional Reporting; ICD-10 Obtaining insurance contracts and provider numbers and CMS Physician Quality Reporting System, Functional Reporting, ICD-10 Managing Employment Liability-Legal aspects of hiring/firing, job performance evaluation, sexual harassment, sexual misconduct, ADA, FMLA In-class presentations of group project DH Chapter 19 EC HH RS RS AP 9
4/17 4/23 4/24 8:25-10:00 4/30 5/1 TBD Managing Employment Liability-Legal aspects of hiring/firing, job performance evaluation, sexual harassment, sexual misconduct, ADA, FMLA In-class presentations of group project In-class presentations of group project No Class Development of Independent Practice; Panel Discussion Final Exam AP Copyright December 1, 2013 by Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO. All rights reserved. Students are prohibited from selling or being paid for taking notes during this course to or by any person or commercial firm without the express written permission of the professor teaching this course. 10