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					Needs Assessment

Statement of Problem: Teaching stress management techniques to patients takes time. Physicians and
other health care providers need to be able to bill for these services. However, most health care
providers are likely not familiar with billing for this type of service. Additionally, it is highly unlikely that
a patient’s insurance would pay for this service. However, health care providers will need to be
reimbursed for the time spent providing these valuable services.

Target Audience: The audience for this training will be health care providers interested in providing
these services for their patients.

Optimals: The optimal would be that providers would understand how to bill for their services in
relaxation training such that they would successfully be reimbursed for their services. Much of this
would likely be direct billing as these services are not typically covered by insurance. Providers would
need to set up a fee schedule based on specific service or on time. They would then use this schedule to
directly bill the patient.

Actuals: Physicians and other health care providers typically bill insurances for the services that they
provide to patients. It is unlikely that many, if any, insurances will bill for these services. Providers will
need to move out of their model of billing insurances and set up a separate feel schedule.

Causes: Physicians and other health care providers are used to billing insurances. However, insurances
do not usually pay for “alternative therapies”.

Feelings: Health care providers, like most people, feel that they should be reimbursed for their work. If
they feel strongly about the worth and effectiveness of these types of therapies, then they would also
feel strongly that they should provide them.

Solutions: This is amenable to a training solution. Health care providers will be taught potentially
allowable CPT (Current Procedural Terminology) codes to bill insurance. However they will also be
trained to develop their own fee schedule.

Format, Learning Situation: This will be one part of our multi-day workshop. This is amenable to a
lecture format, with time allowed for questions.

Sources of information/Data gathering methods to inform the Instruction:

An individual interview with a subject matter expert was a useful technique. I interviewed our coding
and billing specialist for the practice to generate possible codes to bill insurance. I questioned her about
the likelihood of an insurance company paying for these procedures (relaxation techniques, breathing
techniques, visualization), and she thought the likelihood was very low. Working together, we did
identify several CPT codes that might associate with some alternative therapies. CPT codes, according
to About.com, are “numbers assigned to every task and service a medical practitioner may provide to a
patient including medical, surgical and diagnostic services. They are then used by insurers to determine



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the amount of reimbursement that a practitioner will receive by an insurer. “ We identified the
following CPT codes for these types of services:

       97533: Sensory integrative techniques to enhance sensory processing and promote adaptive
        responses to environmental demands, direct (one-on-one) patient contact by the provider, each
        15 minutes. Medicare reimbursement $24.22 for each 15 minutes.
       97124: Therapeutic procedure, one or more areas, each 15 minutes; massage, including
        effleurage, petrissage and/or tapotement (stroking, compression, percussion) Medicare
        reimbursement $20.68.
       97113: Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with
        therapeutic exercises. Medicare reimbursement $31.03.

However it is unlikely that insurers will pay for these services as they are likely not included as covered
services. Individual interviews with insurance company representatives would clarify this issue.

A separate individual interview with a yoga instructor (not Daya) revealed that it is important to pre-set
and “enforce” your fee structure. It is possible bundle fees for related sessions, e.g. $60 for 6 sessions,
but you must bill for the whole amount even if the patient cannot attend all the sessions. Fees must be
negotiated at the start; have people pay before the first service begins, and have written payment
policies. Additionally, you should decide if you will be cash only, if you will accept personal checks,
and/or if you will set up a system to allow you to bill people’s credit cards.

Performance Objectives

A Task Analysis, depicted in the table on the next page, reveals potential areas for instructional
intervention. The worksheet demonstrates the priority of each task. Based on this Task Analysis, it is
evident that one of the top 3 priority tasks is to create a fee schedule. This is the focus of the
instruction described in the objectives below, and in the remainder of this document.

Statement of Objectives:

Terminal Objective: Following a short lecture and question and answer period during their multi-day
workshop, health care providers will create a written fee schedule to address all the new services that
they plan to provide.

Enabling Objectives:

1. Given your new knowledge of techniques and time to practice, identify 2 new stress management
   techniques that you will use in your practice.
2. For the techniques identified in enabling objective 1, describe the time needed to perform these 2
   techniques with patients.
3. For the techniques identified in enabling objective 1, identify all costs associates with providing each
   of these 2 techniques for patients.
4. Considering the time needed (enabling objective 2) and associated costs (enabling objective 3),
   define a fee for each of the 2 techniques identified in enabling objective 1.

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Criteria for Task Selection Worksheet       Criticality   Universality   Frequency   Standardization   Difficulty    Total    Notes                 Priority

                                             30 pts         10 pts        20 pts         10 pts         30 pts      100 pts
Tasks

Describe and document service performed.       10             10            15             5              10          50                               5

Match services performed with CPT codes        15              2            8              10             10          45      Likely not be able       7
(procedure codes).                                                                                                            to bill insurance
                                                                                                                              anyway, so
                                                                                                                              defining codes not
                                                                                                                              high priority

Consider bundling services as a number of      15              5            10             8              10          48                               6
visits.

Create fee schedule.                           30             10            5              10             25          80      Chosen for               1
                                                                                                                              procedural analysis
                                                                                                                              and instruction

Publish fee schedule.                          25              8            5              10             15          63                               2

Define payment options for services.           25              6            5              5              15          56                               3

Define methods for collection of payment.      20              4            5              10             15          54                               4




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Procedural Analysis for Creating a Fee Schedule: The following procedural analysis identifies the
observable steps necessary for a health care provider to accomplish the objective “Following a short
lecture and question and answer period during their multi-day workshop, health care providers will
create a written fee schedule to address all the new services that they plan to provide. ” Each
successive level in the outline presents a finer level of detail.

1. Define the services you will provide
       a. Write a list of services you are considering
                 i. Define which you or your staff could provide
       b. Identify need in your community
                 i. Consider an environmental scan of services already provided locally by other
                    providers
                ii. Consider surveying your patients
       c. Create the final list of services that you or your staff will provide
                 i. Refine after going through all steps below
2. Define the time each service takes
       a. Practice performing the service in real time
       b. Record time
                 i. Consider whether you will need “regular” and “extended” sessions
3. Describe your costs
       a. Define your overhead
       b. Consider what payment you could be receiving for providing other services in the same time
           frame
       c. Describe any costs for materials
                 i. Research costs of materials
                ii. Record costs for materials
                        1. Include any shipping, handling, or processing costs
       d. Consider start-up and advertising costs
4. Define fee for each service
       a. Describe time required for service
       b. Describe costs
       c. Compare time and costs
       d. Consider fees that others are charging in the area
       e. Consider Medicare payment for similar services
       f. Consider surveying patients about what they would pay for services
5. Consider bundling services
       a. Identify services that may take multiple sessions
                 i. Define the number of sessions
                        1. Decide if you will offer a price break for bundled services
       b. Identify different types of services that may logically bundle together
                 i. Define what these are
                        1. Decide if you will offer a price break for these bundled services
6. Compare your fees to others
       a. Identify providers offering similar services
       b. Compare costs of similar services
7. Define possible discounts



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      a. Know the “break-point” for discounts (when the discount crosses the line from cutting your
         profit to costing you money)
              i. Define amount of possible discounts
      b. Define the situations in which you will consider discounts
              i. Identify who in the practice is allowed to give a discount
Assessment

Rubric for Terminal Objective: In developing instruction, creating a rubric helps the designer focus on
the goals of instruction and helps the designer envision “what success looks like”. This rubric will help
the designer make a judgment, over time, about the adequacy of the instruction, based on learner
performance according to this rubric. The rubric can be shared with the health care provider learner, as
a guide to mastering the subject matter. Of likely more importance to the designer is the rubric’s value
in evaluating and refining the instruction over time to make it as effective as possible.

           Terminal Objective: Following a short lecture and question and answer period during their multi-day
          workshop, health care providers will create a written fee schedule to address all the new services that they
                                                       plan to provide.
          Enabling Objective            1 star                 2 stars              3 stars                4 stars
        1: Given your new        Learner identifies Learner identifies Learner identifies 2 Learner identifies
        knowledge of             no new techniques 1 new technique            or more new            2 or more new
        techniques and time to or 1 new                 that the learner      techniques but has     techniques that
        practice, identify 2     technique that the has practiced.            not practiced both     the learner has
        new stress               learner has not                              of them.               practiced.
        management               practiced.
        techniques that you
        will use in your
        practice.

        2: For the techniques       Learner describes       Learner describes     Learner describes       Learner describes
        identified in enabling      the time needed to      the time needed to    the time needed to      the time needed to
        objective 1, describe       perform 1or less        perform 1             perform these 2         perform these 2
        the time needed to          techniques with         technique with        techniques with         techniques with
        perform these 2             patients, but with      patients, based on    patients, but with      patients, based on
        techniques with             little basis on their   their experience      little basis on their   their experience
        patients.                   experience with         with practicing       experience with         with practicing
                                    practicing it.          them.                 practicing them.        them.
        3: For the techniques       Learner identifies      Learner identifies    Learner identifies      Learner identifies
        identified in enabling      some costs              all costs             most costs              all costs
        objective 1, identify all   associated with         associated with       associates with         associates with
        costs associates with       providing 1             providing 1           providing each of       providing each of
        providing each of these     technique for           technique for         these 2 techniques      these 2 techniques
        2 techniques for            patients.               patients.             for patients.           for patients.
        patients.
        4: Considering the          Learner defines a       Learner defines a     Learner defines a       Learner defines a
        time needed (enabling       fee for 1               fee for 1             fee for each of the     fee for each of the
        objective 2) and            technique with          technique             2 techniques with       2 techniques
        associated costs            some basis on           realistically based   some basis on           realistically based
        (enabling objective 3),     either costs or         on costs and time     either costs or time    on costs and time
        define a fee for each of    time needed to          needed to teach       needed to teach the     needed to teach
        the 2 techniques            teach the               the technique.        technique.              the technique.
        identified in enabling      technique.
        objective 1.


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Application assessments for enabling objectives: Following are potential questions assessing mastery of
enabling objectives.

Objective: Given your new knowledge of techniques and time to practice, identify 2 new stress
management techniques that you will use in your practice.

    Q1. Please identify the 2 new stress management techniques that you will use in your practice.
    Please self-assess your knowledge and comfort with the techniques.

        Technique 1:

                → My knowledge of this technique is:

                        1             2                3                4              5
                Not very knowledgeable          Some knowledge                  Very knowledgeable

                → My comfort with this technique is:

                        1               2              3                4              5
                Not very comfortable            Some comfort                    Very comfortable

    Technique 2:

                → My knowledge of this technique is:

                        1             2                3                4              5
                Not very knowledgeable          Some knowledge                  Very knowledgeable

                → My comfort with this technique is:

                        1               2              3                4              5
                Not very comfortable            Some comfort                    Very comfortable

Objective: For the techniques identified in enabling objective 1, describe the time needed to perform
these 2 techniques with patients.

    Q2. The time usually needed to teach a patient the technique of three-part complete breath:
       a. 10 minutes in one session
       b. 20 minutes in one session
       c. 30 minutes over 2 sessions
       d. 45 minutes over 3 sessions

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Objective: For the techniques identified in enabling objective 1, identify all costs associates with
providing each of these 2 techniques for patients.

    Q3. List cost elements to consider in determining cost of one of the techniques that you will
provide (you do not need to define the dollar amount, just the category of the cost, e.g. one cost for
putting on this meeting is rent of the meeting space).

       (Learner should include cost of time spent with the client, any advertising costs, special chairs or
equipment, a share of any other personnel involved in providing the service, and a share of the
overhead costs of the practice (lights, rent, etc.)



Instructional Content:

Following are screenshots from the PowerPoint document that is the proposed instruction to be
delivered to the physicians. As per the needs assessment and contextual analysis, this would be
delivered as a short lecture with time for discussion near the end of the multi-day workshop.
Participants in the workshop would have already had time to learn and practice their new techniques
and also time to practice teaching them to each other.




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posted:1/20/2012
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