The Prosthetics and Orthotics Podcast

The Hidden Power of Good Notes: How Documentation Protects Your Practice and Your Patients with Molly McCoy

• Brent Wright and Joris Peels • Season 13 • Episode 3

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We talk with Molly McCoy about turning dense policy into practical tools, writing notes that get covered, and why advocating coverage can improve outcomes. The focus stays on patient stories, shared decisions, and using the whole medical record to support care.

• how clinician notes function as medical records and drive coverage
• writing people-first justifications that explain medical necessity
• using therapists’ and nurses’ notes to support decisions
• drafting notes in real time to capture shared decision-making
• where AI helps as a writing partner and where it harms
• working with payers while advocating for policy change
• why two devices enable both ADLs and true physical activity
• reducing burnout through smarter workflows and legislation
• telehealth access gains and state-level advocacy
• flexible roles, job sharing, and retaining clinicians in O&P


Special thanks to Advanced 3D for sponsoring this episode.


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Speaker 1:

Welcome to season 13 of the Prosthetics and Orthotics Podcast. This is where we connect with experts in the field, patients who use these devices, physical therapists, and the vendors who help bring it all together. Our mission remains the same: to share stories, tips, and insights that help improve patient outcomes. Tune in and join the conversation. We're glad you're here and hope it's the highlight of your day.

Speaker 3:

My name is Yoris Peels, and welcome to another edition of the Prosthetics and Orthodox Podcast with Brent Wright. How are you doing, Brent?

Speaker 2:

Hey, Yoris. I'm doing well, man. You would never believe it. I picked up another color machine. Oh, wow. Very good. Very good.

Speaker 3:

How many machines do you have right now?

Speaker 2:

So that will be our third color machine. Um, and here's what's crazy about that. You know, a lot of people are not using their color machines to their full potential or what have you. So I so I've actually gotten a few emails like, hey, do you want any more of them? And so that's kind of neat. So I know that somewhere in the pipeline. But uh the other thing is that people are super interested in color and they are finding out that they can do some production of color parts so they don't have to either injection mold them, hand paint them, what have you. And so uh I've actually had a couple just from that one post, I had a couple people reach out for some business stuff of like, hey, do you think you can run some production parts for us in color? And I was like, okay, well, that's neat.

Speaker 3:

Awesome, dude. Well, uh good luck to you picking up on that and then continuing to build your color inventory and stuff like that. And uh, awesome, dude. And um, so who's on the show today?

Speaker 2:

So I'm really excited to have Molly McCoy on the show today. She just was promoted, so her uh an official title is Director of Clinical and Scientific Affairs for Hangar Clinic. Molly is a certified prosthetist orthodist, but has taken a path into of the research side, but then even some of the paperwork, reimbursement, legislative, the back end of stuff that it there's not a lot of thank you for, but it is so necessary to move our profession forward. So I'm really excited to dive into some of that with Molly. And I think you'll really enjoy that aspect too, because it won't be necessarily the technical like stuff that we usually do, but it's the important stuff of like how do we get paid for some of this stuff? How do we do research? How do we make sure this stuff is safe for patients? And so I think that'll be really exciting.

Speaker 3:

Super cool. Sounds really good. So welcome, Michelle Molly. Hi. And and yeah, so first off, like we'd like to know how did you get involved with the OMP?

Speaker:

Super easy story. In high school, I decided I was gonna go to college. So I went to the library and there was a set of encyclopedias of jobs, a career encyclopedia set, and the middle one was P. And I pulled it out and opened it up to the middle part of P and it said prosthetics. And I said, wow, that looks really cool. That's it.

Speaker 3:

That is the easiest some people in the show have like the weirdest, super longest story. This is like the the literally the most direct path into the industry we've heard so far, I think. Yeah. And and so, and what what kind of path do you followed since you've been in the industry? So, you know, brand did so so you did a little bit more on the in the research on that kind of side?

Speaker:

Yeah. So oddly, after that happened and I started looking into what it would take to be a prosthetist, my uncle, because I live in the Pacific Northwest, was a logger and had a logging accident and actually had an amputation. So about two years later, he and I were talking and he said, Why don't you come down here and see what we do where I work? Because after his accident, he uh became a technician. And so I went down to to see what he does and and kind of hang out with him for the day. And someone told me while I was there that it wasn't a great, a great job for girls. And so girls really are are yeah, better suited for the front office work.

Speaker 3:

And this is a long time ago, but I hope so, because that doesn't sound really good. Yeah. Okay.

Speaker:

No, it's not the way I've heard it work now, but this was a while ago. I'm not that young. So of course I said, okay, then I'm gonna do it. So then I came back up to Seattle and opened up the phone book and started calling every single PO shop that I could find and asking if I could get a job or volunteer or whatever. And someone, very small shop, one practitioner, one office person, one tech kind of shop, said, sure, you can clean the plaster traps. So I started working there and going to school at the same time and stayed at that tiny little shop uh all the way through college. And I did every single job you could do there. I was basically just the catch-all. If if no one else was gonna do it, I was doing it. So I obviously helped with the technicians and mostly cleaning up after them and cleaning out the plaster traps and being a hospital helper when another set of hands was needed, helping up front with dictation, taking the clinician's uh dictation and typing it out and, you know, taking deposits to the bank. I mean, you name it. And I did that for probably six years while I got an AA degree, which took me a little longer than most.

Speaker 3:

Okay. And then so the the and would you recommend something like that? Would you re because a lot of people now will go straight to college and then find out what the job is, you know, after they spend a couple of years studying towards it. I mean, would you recommend a certain kind of thing, you know, kind of doing some kind of internship, kind of helping hand helper type of job to just figure out what it is these people do all day?

Speaker:

Absolutely. If you can get it, I would also say, you know, because because a lot of smaller shops, they even now they they can't really afford to pay someone, you know, much money to to do that kind of, I'm learning and you're getting some cheap labor out of it. That that's kind of hard sometimes. But in my opinion, it's absolutely worth it to volunteer that time. I would say uh if if you can't find a paid physician to do that, it is not a waste to just go in and offer to do any job that everybody else doesn't want to do. Because um, yeah, you just you learn what it really is, you see the work happening, you get to overhear what people are talking about. It's just, yeah, an excellent way to learn about PO for real. And I would say the smaller the shop, the better if you can, because really that's the one where everybody is all hands on deck all the time, usually.

Speaker 3:

Okay, that's cool. And then, but you also later on worked in in in kind of much more larger, kind of more hospital, more kind of focused organization. That's very different, right?

Speaker:

Yeah, for sure. So then when I started at University of Washington in the PO program, we used to have this opportunity up here where we would be helping hands for the hospital on call for the level one trauma center up here, Harborview Medical Center. And that was also an amazing education. So while in school, I was also um, you know, about once a month, I was on call to go and do Halo's in the ER to do um up here at that time. We did only kydex custom TLSOs. So, and we cast with plaster for those. So that again is probably not an option for folks now to do that in many places, but just doing that kind of grunt work, being the person that goes with the practitioner and just helps lay down that plaster. And then, you know, we would scan it and carve it and make the kydex TLSO and take it back. And the expectation was about a four-hour turnaround or less. So doing that grunt work, that difficult work, any difficult work that you can find that no one else wants to do, I think is the best way to learn about the profession and learn just what you are capable of.

Speaker 3:

Okay, okay, that's super cool. And then, and so now you do you're involved with like stuff about like documentation and stuff, which I think we can all agree is just like really boring and just some necessary thing you have to do and get out of the way as quickly as possible.

Speaker:

Yeah, I I think we can all agree it's painful.

Speaker 3:

So tell tell us about this documentation because it's like one of these things where it's like, oh wow, that's actually really important and we should probably be doing it better, right?

Speaker:

Yeah, yeah. I think that, well, firstly, the reason I started doing I'm I'm like everybody else, right? I wanted to be in PO because I couldn't write very well. If I wanted to be a writer, I would have been a lawyer. So I think that for me, it was it was a necessity. I had to do something to have a more flexible schedule than a clinic life allowed because of things happening at home. I have a son who has Angelman syndrome and he just needs a lot of care. And I wasn't able to have a clinic schedule and handle my caregiving duties at home. So I thought, well, what can I do to still make a living but be super flexible? And uh I had a mentor at that time who said, find the thing that everybody else hates and get really good at it, and you'll have a niche that will be with you for as long as you want it to be. And that's exactly what happened. So, long story short, I just decided that I was gonna be an expert in Medicare policy because at that time, rack art audits were at their absolute peak. And I knew all these practitioners that I worked with all the time were struggling so hard just to understand the rules, just to know like what are they looking for. So I sat down, I started my own consulting company, and I sat down for about a month and a half. All I did was read Medicare policy and regulations and just made myself an expert in it. And then through doing that, I was able to see that there were actually a lot of things that were we could do as practitioners in our documentation that would make everything easier and just really alleviate the suffering of the note that we don't know how to write, or we go on and on. Either we write too short a note or too long a note because it's just unknown what's supposed to be in there. There was just so much information hidden in this regulation and policy that I thought, wow, if we knew this, we could save ourselves so much time and pain. So um I became an expert in that. And then I went around to my friends and said, hey, does anybody want this service? And I was lucky enough to have a successful consulting company for a number of years doing that.

Speaker 2:

So with the stuff from the Medicare, can you just share with our listeners how does it even come to be? Like who is writing this and why? And that would be my biggest question is a little bit of the history of some of this when it comes to the policy and procedures.

Speaker:

Who's writing the policies and why? Is that what you mean? Yeah. So the centers for Medicaid and Medicare Services, you know, effectively write that policy. And those policies are based on legislation. So you have, you know, the Congress and government agencies, you know, saying, this is what we want to do with Medicare or Medicaid. This is how we want it to run. Then the policymakers at CMS, you know, create policy from that, and then they tweak it every time there's a legislative mandate or input. And the beauty of this American system is that everything is transparent. Everything is out there. The pain of that is that everything is out there and transparent. So what I found in doing this was wow, it was all there all along. But literally the handbook, I don't know if you can call it a handbook at 1500 pages, but the handbook is is published online. 1,500 pages of why they're doing what they're doing, what they expect, who reviews it, what the reviews look like. You know, it's it's every single rule that the Macs have to follow is published. Every single thing that they do in their reviews and their audits is published. So it's really a wonderful wealth of information. And it's also a tsunami of information that you have to get through, which isn't realistic in a lot of cases, but it's out there.

Speaker 3:

Well, okay, so so tell us a little bit like of the things that you know, uh a lot more than just your average person in this industry, let's say. What are some things that people should be paying more attention to or things that you think would be really beneficial if people focus more on just about on the knowledge part of things?

Speaker:

Yeah, I think for clinicians, right? So most of the of the policy information out there is procedural. And that's going to be the admin side of things. You know, here's the rule, here's how you write it, here's how you put it through. Those kind of of rules and regs that that is for the admin side of the house with PO should stay over there. And and we have experts for that, right? But for clinicians, you want to dig through that policy and find only the tidbits that are useful to you and then let go of the rest of it. You have people that that do that, you know, in your practices. So don't get involved in that. We have too much to, you know, to deal with on the other side of things for clinicians to, I think, get really deep into policy. But for the highlights as a clinician, you really want to be aware that what our notes can do, basically. So there was some policy, some legislation passed that made our notes medical record. I'm sure everybody knows that. And what that effectively means every day in practice for a clinician is your note is now elevated and can serve a bigger purpose if you write it in a way that allows it to do that. So our notes really have to explain medical necessity, especially for a Medicare patient, in terms of what is the medical problem this person's dealing with and how is what you're going to provide addressing that in whole or in part. So the first step to that is knowing what the medical problems are. Step one for a clinician working with someone who has Medicare or Medicaid is to get a doctor's note, a general doctor's note. Just understand how healthy or not healthy this person is at a high level, and then make sure that whatever you're providing helps to address some of those medical problems. Then you're in sync and you've got what you need, and you don't have to rely as much on the physician to fill in the gaps. The other thing I think is important to know on that side of things is all the other people whose notes are medical records. So ours are the doctor certainly is, and they're the gatekeeper, the prescriber is. But then nurses and wound care and hospitalists and therapists, they're all in that medical record bucket too, which means you can use any of their notes to help not only guide your decision making, but support what you're doing. You can say, I'm gonna provide an MPK to this patient because I want to address their balance problems or help to address that. And by the way, you can see they have balance problems because look at this therapist note where they're going on and on about the struggles with balance. That is, you know, making a really excellent medical necessity note with uh less effort. Use what's already available, you know, understand what has already been written and use that to your best advantage so that you can write less effectively. And I think I got a little off on a tangent there. What was the rest of the question? Or did I answer it?

Speaker 3:

No, I I think that's good. It's just, it's just, I'm just wondering, like, just giving your expertise, you know, what what should people do, you know, change to do it better, you know? Is it also a question of you do you need to write? Do a lot of people maybe would they benefit from writing more succinctly, for example, or in a particular way or using particular language? You kind of alluded to that as well.

Speaker:

Yeah, that's a really good point. Thank you. Using particular language is helpful. However, using cookie cutter statements or sort of terms across every note that you have uh doesn't work. And I would have told you like six, eight years ago that there were keywords that you should have put in your note for sure. But that's not the case anymore. This sort of stuff evolves all the time. And where we've evolved to right now is you really want to address the person, their need and their and the results you expect when you provide that device. If that's in your note, you are going to be 90 to 100% of the way to what you need to get coverage for that device, whether that's commercial or Medicare Medicaid. But the key there is to focus on the person. You want to talk about the human in front of you, not the component or the device that you're dealing with, which is a sounds really simplistic, but it's actually a really hard mental switch.

Speaker 3:

Do you really literally see people talking about like the AFO or like this super cool AFO robot device rather than, you know, Bob who has problems getting to work? Is that is that really what would it happen a lot?

Speaker:

Yeah, that's absolutely standard. And there's a reason for that. It's not because, you know, I mean, obviously, I would, I think we can generally say that as PO people, we're gadget people. So of course, we like the gadgets. We want to talk about the gadgets, but it's more than that. From what I see, it's a lot that we understand the device at a super deep level. We understand the biomechanics of it, the reason we're doing it, all the different components. I mean, we get that. What we don't often get, and not because we don't want to understand that as clinicians, but mostly because we don't have that. Usually our workflows end up where we don't have the information up front. What we don't typically understand is the patient. We don't know if this person is terminally ill. We don't know if this person is on medication that would cause balance issues. We don't know if this person has had a couple strokes that were mild but affected their ability to process information. This is typically not the data that we have when we're making the decision about the device and when we're writing up the justifications for it. But we do know about the device itself. So it just happens that your note ends up being more about the thing and less about the person, often because of the information that you have available to make the choices that you're making.

Speaker 3:

Does it also matter like when you write the note? I mean, I could be tempting to just put that off. That's probably what I would do, honestly. Put it off until I have to or something in the middle of the night or something. You know, should you sit down write when the person leaves? Because that's also tempting. Oh no, I gotta, you know, I have a next appointment right there waiting. Is there a right moment to do this or right technique?

Speaker:

Let's say I'd go one step further. Don't just write it, you know, as soon as the person leaves. Write it while they're sitting in the room with you. If you have the option to record, transcribe, whatever, you know, write the note while the person's sitting in front of you, that's gonna be the best note you can write because it will capture the collaboration between you and the patient. What payers wanna see, um, and what is better patient care, really, is that you didn't make a decision on your own as a clinician. You made that decision with the patient. You involve them in the process. So as you're sitting there saying, okay, I understand your problem to be, you know, your your foot drops when you're when you're walking and it's causing you to trip. But tell me in what instances that happens. Explain to me when that's happened in your life and what caused it, if you know. And then they explain that. And you say, okay, based on that, I think what might work for you is this type of solution. And then you explain it to them. This is how most people practice, right? You explain, well, this is kind of what I'm thinking about and why. How, you know, what do you think about that? Do you think we that you could make that work? That collaboration, if you're recording that conversation or if you're able to take notes while you're having that discussion, is gonna lead to this note that shows that you didn't make that decision in a silo. You didn't make it around the person, you made it with them. That's an amazing note. And that will support payment.

Speaker 3:

That's cool. And if you see like payment getting rejected or something like for a procedural reason, is it because the notes are too brief or like they're not personal enough, or people leave you know certain things out, or it just seems like they're you know, there's no logical story to it. What are the reasons why these things get rejected a lot?

Speaker:

Yes.

Speaker 3:

Okay, yes, is good.

Speaker 2:

All of the above. Molly, I did have a question for you that so you know, fit you were describing the the handbook, 1500 pages, and and then you know, it's all transparent, so to speak. What do you feel? Feel the role of AI and some of that to help summarize some of it, to understand some of it, to inform maybe better notes. Is there a role here for OP?

Speaker:

Yeah, that's a really good question and framing of it, because I believe AI does have a place as we've talked about before. But in terms of the regulation and the policy and the rules for payment adjudication, my opinion, my personal opinion as Molly, who has looked at these regulations a lot, I believe that that rule book belongs, you know, it has a place in what we do every day. However, if we use it to create a note directly, so let's say you take that 1500 page book and you stick it into AI and you say, tell me how to write, or, you know, give me the questions to ask when I'm writing this note, or tell me how to write a note that that satisfies all these regulations. The results are going to be a note that ends up being sort of a cut paste again, like a template that we've been using to less and less effect over the years. But it would say, you know, ask this question, ask that question, and there'll be yes and no answers. And we could check those boxes. And then technically you would have all the regulations met. However, the beauty and the curse of those regulations is that they're written in a way to have a lot of gray area. That's great for us because it means that we have a lot of leeway in how we explain what we're doing and why we're doing it and how it improves this person's health or function. If we just write a note based on the regulations and the rules around payment adjudication, then it would be very easy to remove that gray area and just turn everything into a form. And then we are ending up in the situation that we see people like uh wheelchair technicians are in now. So back in the day, you could get a certification to make custom wheelchairs and to be a wheelchair technician. And then, or I can't remember what it's called. Maybe you guys know the, you know, accredited or or something wheelchair specialist, or they had some title. But you could, you could do that as a to make your living and you would explain that I'm making this custom device. Um, it's customized in these ways, blah, blah, blah. Well, they didn't give those clinical details. They didn't exploit that part of the policy that allowed them to show their clinical expertise and why their knowledge was important in the creation of this device. And over a few years, that was removed. And now physical therapists have a form that they use. They make the decisions about what type of wheelchair components are gonna be used for that patient. They fill out a checkbox form, the doctor signs it off, and that wheelchair technician just needs to do what they're told. They are just gonna fill that list of components, stick it together, and hand it over to a therapist. They literally lost that ability to be part of the clinical team. Now it wouldn't be all because of them not writing good notes, but you can see a direct line to losing that ability to be a clinical decision maker with the team because of that missing component where they said, you know, we have gray area. And in that gray area, we're able to say, this is why I'm doing what I'm doing, this is how it affects the patient, this is my area of expertise. And I will explain why this is going to help this person be healthier or more functional. And we still have that in PO. So while yes, you could use AI to spit out a form letter that hits all the points of regulation, honestly, it would be a disservice to all of us and to our patients to remove our clinical expertise from that equation. So using AI on the other end of it, where it becomes a writing partner for you, where you're able to say to Yoris's point earlier, this is all the stuff I'm thinking about. Now, can you make that into something more concise, but still a narrative, not a checkbox? That is, in my mind, the perfect marriage of AI and clinical expertise.

Speaker 3:

Yeah, though, I'd also like to point out something like just over the last two or three days, we've been doing uh we're trying to come up with a couple of brands, right? And we've just been using AI a lot just to just to help us brainstorm. Not like a and it has kept, it keeps lying about stuff. It keeps making up stuff. Like uh about certain trademarks, uh certain websites it says it checked, it didn't check, uh, names, what they mean and stuff. We keep finding that in just even a context like that, it just kind of continually makes up stuff. So I definitely would caution to never use it in a protect in a final product of something in a professional context, especially something that has like a legal thing in a professional context. Because it just actually uh there's a lot of lies in that system that somehow come to the fore. And we've uh it's really weird about what uh the the true meaning uh meanings are, certain Norse gods or where certain plants come from, stuff like this. And we've all found uh repeated lies in the last couple of days. I would be really careful uh before you trust it with like, you know, saying which article is which article or a certain certain things that you would rely on to get the recompense and things like that.

Speaker 2:

Aaron Powell And don't use it to create G-code. Or modify G-code.

unknown:

Yeah.

Speaker 2:

I don't know of anybody that did that, but uh I did have a machine that was just spitting out filament in the middle, and uh I may or may not have asked uh ChatGPT to modify my G-code in it completely.

Speaker 3:

I've done from scratch, I've done those STL, you know, those image to G code thing. That kind of has worked out, but yeah, just you know, scratch making a G-code, I haven't tried that yet, so okay.

Speaker 2:

So anyway, yes, AI, boy, that was a squirrel, I guess. All right.

Speaker 3:

So Molly, like talk to us a little bit about like, you know, uh, we're talking before about that, you know, I can imagine a lot of people were like, I'm not gonna read the 1500 page thing. Good idea that it's supposed to be narrative, but they they they they kind of would see it as a uh as a kind of a thing that would you know not be as important as maybe it should be to them. Are there best practices? Are there further things you could do? You know, can you outsource this? Can I just tell someone else to do this? Or is it something I should be doing myself? Well, what can I, if I'm like not like you, let's say, what can I do to make myself better in doing this?

Speaker:

Let me see if I understand that question. You mean are there some ways to make the note better?

Speaker 3:

Aaron Powell Yeah, or make me as a practitioner better at making notes. I mean, I can just imagine there's some people that would just like do this well, and there's other people that would just like, you know, look up again, yeah, look at this as kind of like a chore and just not do it well ever, and maybe, you know, lose out on business, maybe you know, spend a ton of time resubmitting these notes and resubmitting uh requests and stuff like this, or maybe even like, you know, be financially very negatively impacted by by all these kind of rejections all the time.

Speaker:

Yeah, yeah. I think I'm not being flippant when I say this, but if you can't type, then you need dictation, right? Because you and if if you can't take, if you can't speak in a succinct way, which I would say I can't, as a general rule, I tend to be pretty pedantic and long-winded. So if you can't type, use dictation. And if you can't keep it concise in your in your thought process as you're dictating, use AI. Right. So you you're the worse you are at at creating a note that works and and keeps you from having to rewrite or have these denials over and over, the more tools you should be using to help you do that. If it's really bad and you just you you can't seem to get the ideas out there and it's really hard to articulate what you're doing and why you're doing it, then it behooves you to spend a little money in that area and maybe have a human scribe with you. Maybe have someone with you in the room that you can train up that will ask you the questions and draw the answers out of you. But, you know, when you're being impacted negatively financially, you really have to take a step back and say, how, you know, I probably need to make an investment in this area because frankly, you know, notes and communication of our clinical rationale is all we're here for, right? And anybody, I mean, again, spe speaking as a prosthetist who's been doing this for almost 30 years and I love it dearly, anyone can put the parts together. Whether they put it together right or not is a different story. But our clinical expertise comes in how we take the patient's situation and turn it into something that improves that situation. It's the processing, it's the thinking about it, it's the understanding the biomechanics, but breaking it down in a way that a clin that a patient and a doctor and a therapist who aren't familiar with prosthetics, how they can understand why this thing is important and how it does what it does. And if we can't do that, then the investment to help us do that better is worth every penny. And a lot of us can't. I mean, again, I I use AI too. And it's because I tend to be long-winded, if you haven't noticed. It's because I have a hard time, like just getting it down to the fine points and just getting it down to the relevant segments. But I don't think you need the policy to do that. I think the main goal is just to say what is important to the patient, explain how it's going to make this person better, and explain what the result is that you expect. And then follow that up.

Speaker 2:

Is it a reasonable expectation too? Like if let's just say I'm using AI on my side, is it reasonable to assume that AI is being used on the authorization and insurance side?

Speaker:

Yes. Again, the transparency that we have in these federal agencies and institutions is amazing. They've already told us that. If you look in those regulations and policies on page, you know, 797.ac3 or whatever it is, um, you will see that they've said we would encourage MAX and other, so that's the Medicare administrative contractor, right? The people that actually process the claims. We would encourage them to employ things like natural language processing and other AI-assisted or algorithmic services or software to process these claims. We know that they do it for claims. Now, I don't have anything that says specifically, just to be clear, that pro, you know, no prosthetics and orthotics claims or notes are specifically being processed by AI tools. But there's no reason to think that if they're using it in every other space, they aren't using it for ours too. And you're right. That I mean, I think that's really important that if they're ramping up their capability by using an assist like AI, it just makes sense for us to also do that.

Speaker 3:

Okay, that's that's cool. And then and beyond that, what what do you think of this like everybody always complains? We always like get partitioners stuff complaining about regulations, about things. Is that really useful? Should you see it in kind of like a more cooperative light? Or should should you just like, you know, is there a mindset change that we could do? Or do we need to like bring the whole system down because it's not, you know, it's it's it's evil?

Speaker:

Yes. No, I mean, I think I do think it's both, right? So we want to engage in legislative activities and get out there in front of policymakers to say, hey, this is what we do, this is why it's important, here are the people we work with, this is the needs that they have that aren't being met by the current healthcare system. We want to be in lockstep with our patients, out there advocating for change at the highest level, you know, the congressional level. At the same time, trying to make congressional level change by writing a snarky note back to a reviewer after a denial is just frankly dumb. It doesn't work. All it does is hurt you. So, you know, day to day, it's do what you're required to do. Make sure that you're getting paid for the services that you provide. Consider the payer as a partner and try to work with them and ask questions and don't be afraid to reach out and say, I really don't understand this denial. Can you tell me what's going on and get support to make better notes and get those claims paid? And at the same time, work with uh groups that are making legislative change so that you don't have to work so hard every day.

Speaker 2:

So I want to hop into some of the things that you you are seem to be very passionate about too, like especially on that legislative side of things. That seems like it's going to make a difference for the future of our profession. And I'd love for you to share a little bit about the so everybody can move and some of the legislative stuff that you do. And then I know you're involved with the academy and such. I think that is also important at the individualslash company level stuff. So I I know that's something that you're passionate about.

Speaker:

Yeah, as far as the so everybody can move legislation, um, am passionate about it for all the reasons that everybody else is. You know, I I absolutely believe that people should have what they need to be physically active because we know the physical activity is what makes people healthier full stop. So if I can't, you know, enable someone, if I'm providing only the device that allows them to do basic ADLs, like, and we know what basic ADLs are. Let's not fool ourselves that it's more than this. It's eating independently, getting dressed, toileting. You know, it's the most basic life-sustaining things that you do during the day. It is nothing to do with getting into the community, having an active life, being involved, being healthier by being physically active. None of that is included in what we would typically be reimbursed for for our devices. So things like so everybody can move legislation are super important in order to say, we don't have, you know, as a general rule, we don't have devices that do both. We're either gonna give you something that has a lot of control and will get you stable to do these basic life skills in a safe way, or we're gonna give you a thing that allows a little more freedom and but also is a little less stable, but you'll be able to run in it, you'll be able to jump, you'll be able to, you know, move your limbs in a way that is, you know, maybe not safe for standing at the bathroom sink, but is safe for Tai Chi at the community centers. You know, we have to make the world aware that our technology is incredible, but it's limited in some ways. One of those ways is you kind of need two devices in order to do your regular daily activities and an extracurricular like, you know, physical activity that increases your heart rate and makes you healthier. So that's the beauty of the So Everybody Can Move legislation in my eyes. But even bigger than that, the reason I get really excited about it and I wanted to be involved in passing that legislation in my home state of Washington and supporting that group uh federally is because I see it as a way to decrease clinician burnout. What we see so much is young, bright, excited people coming out of college with their advanced degrees and PO and getting into the clinic and having their hopes and dreams crushed by just the grind of clinic. The clinic grind is real. It is hard. Healthcare is hard. I'm not telling anybody that's something they don't know, but that daily grind in part comes from being a person that wants to help people get healthier and be the best that they can be, and being limited in what we can provide. So to sit in front of somebody and say, I know the thing that will make you happy, healthy, and will make all your, you know, physical healthcare dreams come true, but I can't give you that because of, you name it, policy restrictions, payment problems, inability to write a note that supports it in a way that a payer will accept and all the reasons, right? It's not that we couldn't provide it. It's that all this other paperwork or regulation prevents us from doing so. Happening every day is like these little, little tiny cuts. Every day I have to do something less than optimal for a patient. Every day I have to give them something that's close to getting them where they need to be, but not quite there. And that wears on people so quickly. This is known, there's research about this, this happens in every part of healthcare that doctors, therapists, nurses, everybody, including us, has this problem where we have the ability, we have the technology, and we can't do it because of all these regulatory issues or time problem or whatever patient engagement problem. So, with so everybody can move legislation, the idea that I could sit in front of a patient and say, actually, we now have legislation, we have a law in place that allows me to give you two devices. One that will make it possible for you to do your daily activity, like your basic functional stuff to make you a functional human with less support from a caregiver, but also a thing that will enable you to get physically active and try some new things, maybe try a sport. That gives an antidote to burnout, I think that is immeasurable. It allows us to do what we used to do. I hate, I hesitate to even say it back in the 90s, when we were, when we were maybe more able to provide things that served a lot of purposes or to give people a little more range in in what would be covered or not that they could have access to. And it's a, it's just an amazing thing. It makes the job less of a grind.

Speaker 2:

What do you think as far as there's always I think tipping points in OMP? And I think part of some of those tipping points for pushing into some other technology, even into the documentation side of things, was COVID, when people were needed to be home but still needed to fill their time with something. Do you feel that, at least on the 3D printed side of things, I see that that was a big turn. But do you find that COVID affected anything really for I know it wasn't a great time for anybody, but for the better on this idea of the documentation side of things?

Speaker:

Yeah, I mean, it it gave us huge access to telehealth, and that's fabulous. The fact that people can have more communication with their physicians, especially through telehealth appointments instead of in person, especially for our patients who are mobility challenged anyway, it's a big deal. And it it could allow access and communication that could really enable that person to do more than they would have been able to do without it. So yeah, I do think that COVID, there were some good things that came out of COVID, telehealth access being one of them.

Speaker 3:

And and a little thing about the this this this, you know, first off, on the state level, a lot of people may not think about lobbying or doing any kind of legal stuff on the state level. But you're, you know, from your example, it seems like it could be really, very powerful. Do you think more should be done by by uh you know, by maybe even individual uh practitioners and stuff to to do kind of uh stuff on the state level?

Speaker:

I mean, yes, we could all do more there, but I think, well, I know what I hear from practitioners all the time, and I'm sensitive to is I don't have time for that. I don't even have time to see all the patients I need to see. I don't have time to get the hospital work done. I don't have time to write the note that's gonna work. This, again, is where I would say that when you look at your practice and you see where the time suck is, it's worth your time and effort to invest in that in some supportive tool there, whether it's a person or an AI or a whatever it is, dictation, whatever. If documentation is preventing you from having time to do the other parts of the practice that need to happen, along with working on legislation and interfacing with your lawmakers and your To help them understand what you do and why it's important, then fight, you know, then the investment is absolutely worth it. The cost of engaging a tool to help you with those things is absolutely worth it. So it's both and yes, everybody should be more involved in legislation. Everybody should be more involved in telling lawmakers what we do and why it's important again. But also you can't just add that to your plate. You've got to unweight somewhere else. And so that's where it takes some creativity in how you look at your practice and where you'll be able to make investments that make a difference. Legislation works quicker than people think.

Speaker 3:

Okay. And another thing I think, yeah, I'm glad you addressed this burnout issue because, like, you know, there's always like magically not enough people in OMP, but there are a lot of people starting out. I mean, how big is this burnout problem? Can you do you know how to quantify it? Has anyone like really successfully seen, you know, how important this is or how how how how bad it is for the industry?

Speaker:

I don't know of any numbers. They're they're probably out there. I haven't seen them. I personally, as a female in the field, have this sort of, you know, draw to other female practitioners. So just my own experience is I reach out to young female practitioners all the time and say, hey, how are you gonna balance, you know, if you want to have a family, how are you gonna balance that with clinic? If you want to pursue a higher degree after this one, how are you gonna balance that with clinic? Like helping people think ahead about how that's gonna work instead of just falling into it and then finding that they've burnt out has led me to the, to the conclusion that quote unquote, a lot of people are burning out and leaving the field. And there's a million reasons for it. The ones that I see the most, again, are more female focused. So it often what I hear from folks I, you know, am supporting or teaming up with is I had a child and I couldn't do, you know, shared work. I couldn't do a job share to make it possible for me to be a mom and uh practitioner. Or I have a sick parent and I have to take care of that sick parent and I need more flexibility in clinic and I couldn't make that happen. Or I'm just tired all the time because I've got other draws on my time and energy and I can't manage the, you know, weight of clinic along with all those other things. So I think it's a huge problem. I don't know any numbers specifically that are out there, but we do know that in healthcare overall, the burnout rate, again, I don't know the exact numbers, but I know that when I've looked it up for physicians and nurses and therapists, it was jaw dropping the number of people that are leaving healthcare because they just can't handle that and they're burning out. It's it's a problem.

Speaker 3:

Yeah, and I think it's also great that the well, another thing that like a bad thing usually is like, especially for women in that position, like, um, you know, there usually aren't that a lot of like good part-time jobs to take or something like that. I know that the the women I know, like they took, you know, basically a step back. So they were working but at a much lower level, or they couldn't work for for for a number of years, which is of course very detrimental, I think. And it would seem that I think, you know, the industry could do more to make these kind of, you know, more meaningful part-time work, or to do things with practices to to kind of uh let people kind of work uh a little bit of a slower uh intensity, let's say for a number of years, and then come back in full force.

Speaker:

Exactly. Yeah, I totally agree with that. And I should say, like women, that's who I interface with, but this is a problem for men too. I I'm not saying that men don't have that caregiver role as well. So really it's anybody. Since we have a shortage of practitioners and we know burnout is a problem at some level, we need to become more creative on how we enable people to stay in the field. And exactly agree with that. That if if someone comes to you and says, I need more flexibility, I need different hours, I need some other kind of way to balance this out, we are absolutely doing the field and our own practices a disservice if we don't get creative and find a way. And there is a way. I mean, that's what we do for a living, is we get creative and we solve problems. So there's no reason that we can't solve the problem of needing a more flexible work schedule, working weird hours. Why don't we have we see more practices offering weekend hours for people that can't, you know, for practitioners and patients that couldn't make it on the weekdays? Why don't we see more people offering late hours or early morning hours to accommodate schedules? I mean, I think you don't see it very much in healthcare as a general rule, but that should change, in my opinion.

Speaker 3:

It always sounds like a really useful thing to do, let's say. And and yeah, and just generally like of yourself, like what has really worked out for you and and and your time in this industry? Like I think it's interesting you designed your own job. I think that's a really cool idea, right? I think a lot of people would just not think like that, you know? And is are there other tips like that you could offer to people?

Speaker:

Yeah, if if being completely desperate is a tip, then uh yeah, you could take that away. I think that desperation is what led me to all these weird jobs that I've had. Literally was not able to do the thing that I wanted to do the most, which was see patience every day. I couldn't do that. But I also was unwilling to throw away the education that I had spent so much time and energy and money getting. So I just went hat in hand to anybody who would listen and said, here's the thing that I can give you. Here's what I know, here's my value. Um, and here are my limitations. I also have these limitations. Let's talk about this. And I was rejected like everybody, I was rejected more times than accepted with those ideas. There was so much no before there was a yes. And I know that's a trope. I know people say that all the time, but you just, if you're, if you need flexibility, if you need something different, you really have to be willing to work with people. Maybe you're gonna take a pay cut, maybe you're gonna limit your hours or do some weird job that nobody else likes. You've got to be able to be open to that, at least for a time, or you know, or you're not, you're not gonna have those opportunities. So I think it's just super important that people don't get stuck on that linear pathway thinking I've got to always be moving up the ladder. I've got to always be making more money year over year. I always say this when I when I'm talking to groups about a career path is I graft it out. I have taken more reductions in pay over my career than I have increases in pay. Very literally. I would go up the ladder, make some money, and then something would happen and I'd have to do some weird job that took that I took a serious pay cut for. But in the end, the trend line is up. It's just that it took, you know, many, many years to do that because I was willing to take a pay cut. I was willing to work a weird job that nobody else wanted. And I I think that you can always come back to the things that that fill you up or you can turn the weird job into something really cool if if you are open to it and it's worth it.

Speaker 3:

All right, Molly. That's a really wonderful note to end uh end on. I think I think it's uh really wonderful that uh you took the time to be with us today.

Speaker:

Thank you guys very much.

Speaker 3:

And thank you for being here as well, Brent.

Speaker 2:

Well, this was great. And thank you for thank you to Molly for pushing in the directions uh and uh for not only the legislative stuff but the paperwork side of things. I know it's thankless. So thank you for uh doing that and encouraging others along the way to uh do the same.

Speaker 3:

Awesome. And thank you very much for listening. Have a great day, and thank you for listening to the Setics and Anatolics podcast.

Contributor

Brent Wright

Co-host
Contributor

Joris Peels

Co-host