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BACKGROUND AND PURPOSE:Todays physical therapists (PTs) are confronted by a complex set of insurance and regulatory requirements. Third parties such as Medicare, Medicaid, and private health insurers pay the majority of claims for physical therapy services. These third-party payers impose restrictions on the provision of physical therapy services in the forms of financial caps, deductibles, copayments, coverage limitations, and benefit restrictions that may change on an annual basis. Restrictions such as these have affected access, frequency, and duration of services provided by a PT. In addition, with the gradual implementation of the Patient Protection and Affordable Care Act (PPACA),1 clinicians have an unprecedented need to understand current health care and insurance policy regulations to provide patients quality care in an efficient manner.There has been a coinciding call for educators in multiple health professional fields to enhance learning experiences on health care policy, health systems, and cost containment strategies2. Patel et al3 studied the responses of 58,294 United States medical graduates and reported that less than half of the respondents believed they had been appropriately educated in the practice of medicine, defined as medical economics, health care systems, managed care, practice management, and medical record keeping. Although there is no existing literature describing PT student perception of their preparation in practice management, it is reasonable to expect that the results would be similar and that increased attention to this area in professional level PT education is warranted. Jette et al4 investigated occupational therapist (OT) and PT clinical decision-making for patient discharge planning from acute care settings and noted that insurance policy and regulations are important factors considered by hospital staff during discharge planning. They suggested that academic programs should consider if students, prior to internships, are sufficiently prepared for clinical decision-making that includes consideration of financial resources and regulations.The authors of this paper believe that practice management content (eg, documentation, insurance policy, and regulations) should be incorporated into the learning process as a component of clinical decisionmaking rather than as an isolated course. As the students learn to develop clinically sound plans of care, they should consider applicable insurance and regulatory policies that directly affect the care as they collaborate with the patient and other health care providers. By threading the material throughout the professional level physical therapy curriculum, students have the opportunity to contextualize this knowledge in the practice area they are studying, incorporate the information into their clinical decision-making and patient management skill set, and create a more realistic plan of care that may lead to improved outcomes.The purpose of this manuscript is to describe a case-based reasoning (CBR) approach to enrich student learning in insurance, regulations, and documentation in a professional level PT education program and assess the outcome of the instruction on student clinical performance. In addition, participating faculty perceptions were assessed to determine the effectiveness of the curricular changes. Specifically, the authors describe a CBR approach that uses active learning methods, progressively complex case studies, and clinical reasoning to integrate insurance, regulatory, and documentation content into a professional level PT education curriculum.Case-Based Reasoning (CBR): An Opportunity for IntegrationContemporary education theorists have shown that learning is most effective when students are involved in real-life, situational learning activities.5,6 Students participating in educational endeavors using problem, project, and CBR methods are more motivated to learn, use information effectively, and develop higher order thinking skills than those that are exposed to teaching methods using rote memory. … |
