The Evolution of Compliance in a Physical Therapy Practice

The Evolution of Compliance in a Physical Therapy Practice

It seems that every time we turn around, there is a new requirement for documentation, education, reporting, or delivery of care. As therapists, we often find ourselves wondering who continues to dream up these excessive and draining restrictions, and why they would add one more thing to a plate that's already full. As the poet Taylor Swift once said, “It’s me. Hi. I’m the problem, it’s me.”

In the ‘90s, my first job was working as a rehab tech at a large hospital near Chicago. I helped transport patients to the gym for rehab or wound care. Prior to getting the patient into a wheelchair, we pulled paper charts for the nursing staff to verify the patient’s medical status hadn’t changed and nothing would keep them from attending therapy. A common physician note for a patient encounter was “Afebrile.”

We’d joke about how useless the commentary was, as it provided next to nothing about the patient’s condition other than the fact their temperature was normal. We would then bring the patient to therapy and write their PT note. If you treated in the 1990s, you could likely tell me what it said:

S: No new c/o

O: See Log

A: Tol well

P: Cont.

If there is something I’m embarrassed about in my patient care journey, it’s that I wrote this note. It was pervasive and in common use in all settings. It was horrifically nonspecific and added nothing to the importance of documenting patient progress or representing the skill of the physical therapist in the delivery of care. We felt we didn’t have to justify our services to anyone, so we didn’t.

It was an unfortunate reality that we  no value for the service we provide, no justification for the expense, and no concern for continuity. We delivered the most exceptional care in the medical world at the time but were such poor historians that we were unable to defend ourselves when insurance companies called us out.

When purse strings tightened, medical reviews and denials moved into the forefront. Then compliance became the new profession within the profession. Our own failures allowed payers and regulatory agencies to set standards for us because we failed to demand more of ourselves. Honestly, I’m thankful they stepped up where we didn’t. The profession needed accountability and an objective bridge between delivery of quality care, the definition of quality care, and the verification of delivery. We should have done it, but didn’t, so they did.

Fast forward to today, there may be a lot of grumbling about compliance and talk of “extra” work to meet all the requirements. As someone who lived through it, all I can do is assure you that — as a profession — we did this to ourselves. The people who guide us in compliance are helping us prove our excellence and our value by bringing us up to the objective standards we should have had all along.

We have moved academically and professionally into a doctoring profession. We need to stop doing the minimum (as defined by the payers or legislators) and be exceptional. Compliance professionals are our gauge for that. They help us increase access while we stay within the parameters of quality care. Appreciate them. Lean into their expertise before there is an issue.

Compliance is not a dirty word. It is not a punitive element of what we do. It is a natural outflowing of the optimal delivery of care followed by proper billing and documentation practices. If we want the recognition we deserve as a profession, we need to acknowledge the errors we’ve made.  We need to be collectively better at rectifying the impression we’ve left. 

We need to be proactive about providing and proving value until our default behaviors are maximally compliant, and Compliance professionals can start looking at what we’re planning to do instead of what we’ve done.  Taking back ownership of our profession from both a reimbursement and compliance standpoint hinges on our ability to be as undeniably excellent as we truly are.