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# of sessions question
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# of sessions question - January 23, 2007 9:54:00 AM
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ysumpt2006
Posts: 114
Joined: March 31, 2005
From: Youngstown, Ohio
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Got a question for you folks that have been in practice for a while. What is the best way to address my colleagues habit of sticking to "x" amount of sessions as dictated by the referring physician?
The PT's I work with are getting confused by way of the script that may say 3x/week for 6 weeks and automatically wants to treat them for 18 visits, no matter what.
I am a new grad and believe "treat them until they are making progress and then let them go--doesn't matter if the script states 1 visit or 60 visits".
How do I keep from making the PTA's confused too much?
I have discussed this with my boss and he told me I was doing it right (which I knew), but I am constantly at a battle with the PTA's and my fellow PT's.
Is it just a different generation of PT's?
I won't change, unless I'm made to, but I believe this is the way to be.
Thanks
Ken
_____________________________
Ken Shearer, PT
Certified Strength and Conditioning Specialist
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Re: # of sessions question - January 23, 2007 11:58:00 AM
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yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
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Ken:
Several ways to handle it. The most powerful is the threat of insurance fraud. Secondly, your plan of care, which is signed by the referring physician could be different from the referral. Also you can refer to discharge criteria outlined by the APTA. You are doing the right thing.
What are their arguments?
Eric
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Eric Yarrington, PT, MPT, OCS
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Re: # of sessions question - January 23, 2007 12:27:00 PM
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ysumpt2006
Posts: 114
Joined: March 31, 2005
From: Youngstown, Ohio
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Their arguement is that if the doc wants x visits, that is what the patient gets.
It was just brought up during a conversation regarding how many sessions I see my patients before I discharge. The PTA that asked me had never worked with a patient of mine and when I stated that I like to discharge when I see progress regardless of the number of visits, a co-worker overheard me and stated that he does the exact number of visits that is on the script. Couldn't really give me an answer as to why.
They have been practicing for 9+ years, so maybe that is the problem--getting stuck in the "this is how I learned it 10+ years ago" mentality.
Heck, I have seen people in this clinic in pool therapy for a year. Or 12-16 weeks for TKA.
I routinely have a high turn-over rate when it comes to patients because of the fact that they are getting better--when I mentioned this as a reason, my co-workers just laughed like I was telling a joke.
I had to make sure I let my supervisor/director in on my M.O. as he is not a therapist. He agreed, but I'm not sure what will be done about the others--I'm just going to do what is best for my patients.
_____________________________
Ken Shearer, PT
Certified Strength and Conditioning Specialist
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Re: # of sessions question - January 23, 2007 1:22:00 PM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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I agree for the most part, but don't ever kid yourself into thinking medicine is not a business. If you have a Rx and authorization for say 10 visits and a patient is mostly better at 8, I can see DC if no more goals to be made etc. BUT let's say they can still use work conditioning or return to sport type of training and you had 4 more visits authorized and you DC when progress can still be made, I can see as a director me getting a bit pissed. But push comes to shove, you are doing it correctly, just try to put yourself in the shoes of an admin too
Ben
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Re: # of sessions question - January 23, 2007 4:02:00 PM
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jma
Posts: 2414
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From: NY
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You are doing the right thing. Agree with previous posts as well.
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Re: # of sessions question - January 24, 2007 2:06:00 AM
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PTupdate.com
Posts: 1477
Joined: October 8, 2001
From: Pittsburgh, PA USA
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I also agree you are doing the right thing, and agree with Ben as well.
Make sure you are not discharging people too early. There are PT's that tend to drag things out, and there are those that cut people loose too early as well.
If progress is still being made on a weekly basis for some parameter, be it pain, ROM, strength, or biomechanics, see if the patient wants to stick with it. Explain what could occur if this deficit is NOT corrected, and leave it up to them.
Something I often do, especially in patients who are hesitant about discontinuing PT: Tell them you'll hold their chart "open" for a few weeks. If they feel they regressed during this trial period, or levelled off, then return. If I don't hear from that person in a few weeks, I assume all is OK and then discharge them.
Tell your PTA"s the script for "18 visits" usually means up to that many, just like 300 Naproxyn tablets. Use as needed. If you speak to these physicians, most will say not to use all the visits if not necessary, and that communication can be tossed right back to the PTA's
John Duffy, PT OCS
[URL=http://www.PTUpdate.com]www.PTUpdate.com[/URL]
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: # of sessions question - January 24, 2007 4:20:00 AM
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ysumpt2006
Posts: 114
Joined: March 31, 2005
From: Youngstown, Ohio
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Well, when it comes to my d/c's, I routinely put people on a 1-2 week hold before the final d/c to give them the time to see how things go on their own--I liken it to a safety net for them. Most take it and then call me if they need to come in.
Thanks all.
_____________________________
Ken Shearer, PT
Certified Strength and Conditioning Specialist
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Re: # of sessions question - January 24, 2007 2:49:00 PM
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drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
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Do you guys (and gals) use a trial of withdrawl from care? I'll usually give the patient 2-4 weeks off and bring them in one last time before discharge. This allows them to progress with HEP and makes sure that nothing new pops up along the way.
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Re: # of sessions question - January 25, 2007 3:46:00 AM
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ysumpt2006
Posts: 114
Joined: March 31, 2005
From: Youngstown, Ohio
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As I stated just above your post--I do a 1-2 week hold time with my patients. I then bring them back in for a final progress check, then D/C if appropriate.
_____________________________
Ken Shearer, PT
Certified Strength and Conditioning Specialist
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Re: # of sessions question - January 25, 2007 3:06:00 PM
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PhysioThis
Posts: 84
Joined: October 23, 2006
From: New York
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Ken,
Do an in-service for the staff. Use the Guide as a reference. Enlighten them. Never forget the business aspect of the job. Never let a pateint feel "cheated" because their authorized visits went unused.
What you're dealing with is a facility culture vs. "old school" PT. I graduated PT school about the same time your senior PT's did, and I practiced exactly as you do when I was out of school (continue to do so today), because it was what I was taught.
Use this as an opportunity to improve practice where you are, and to demonstrate initiative, leadership, and innovative peer education.
_____________________________
Ed, PT, MTB-XC
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Re: # of sessions question - January 25, 2007 3:20:00 PM
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matotoms
Posts: 57
Joined: February 16, 2005
From: nbn
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max out everyone and take the money, it wont be around forever. The more patients your PTAs have on caseload the less stressed they are = better service.
besides it is either you do the service and get the ins co money or the ins co keeps it and redcuces reimbursement rates and number of visits in the future anyway.
its not like it is difficult to prove how any patient can benefit from a treatment or 2.
Why do the ins companies bidding, unless you are on a capitated contract. screw them, they suck and are the epitome of evil. Get over your idealism and join reality.
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Re: # of sessions question - January 25, 2007 3:53:00 PM
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ianwvu
Posts: 71
Joined: June 11, 2004
From: Glendale, AZ
Status: offline
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Yes yes yes, Milk it, max them out. Insurance people suck, great. True, most all insurance reimbursement keeps getting worse, but you actually think maxing out visits and charges just for the hell of it really helps the issue? PT's who abuse the system can take part of the blame for increased insurance premiums, and lower reimbursement. As insurances pay out more and more because of practitioners with the "bleed the insurance dry" attitude, the insurances want to keep their profit margins, so to do that, they pay us less, and charge the patient more. Not to mention putting a drain on the patient via time off work/ copays.
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Re: # of sessions question - January 25, 2007 5:26:00 PM
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rwillcott
Posts: 435
Joined: March 20, 2006
From: Canada
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mt,
awful advice.
Rob
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Re: # of sessions question - January 26, 2007 2:18:00 AM
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USAPT
Posts: 278
Joined: January 14, 2004
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I agree with Rob.
MT, given your tone and cynicism, I hope your are not a CI or have anything to do with teaching PT students. I feel sorry for your pts. What ever issues you have going on, get some help but do not abuse the system the rest of us are trying to uphold as best we can.
_____________________________
Jason, PT
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Re: # of sessions question - January 26, 2007 3:53:00 AM
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jbird007
Posts: 297
Joined: May 2, 2006
From: USA
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Have them pay cash, they get better even quicker.
JBird
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Re: # of sessions question - January 26, 2007 7:22:00 AM
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ysumpt2006
Posts: 114
Joined: March 31, 2005
From: Youngstown, Ohio
Status: offline
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MT, thanks for the advice, but I'm a lot more ethical than that. The In-service is a great idear.
_____________________________
Ken Shearer, PT
Certified Strength and Conditioning Specialist
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Re: # of sessions question - January 26, 2007 5:21:00 PM
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savela
Posts: 63
Joined: October 7, 2004
From: toronto
Status: offline
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Hi,
Correct me if I am wrong ( I am from Canada), but my goal is to DC when the pts. are functionally better.
My pts. pay cash, and hopefully, my treatment plan will be sucessfull, before their insurance runs out.
I hope the some of the above posts are kidding?
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