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Distinction of PT
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Distinction of PT - July 31, 2005 11:47:00 AM
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vt2c1ms
Posts: 74
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From: Kansas
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I have a question. What makes the PT distinct from all other similar professions, DC's--etc. To be more exact, what can a PT do that no other profession can bill for making the profession a true autonomous profession?
Thanks for any responses,
Mark (DPT class of 2008)
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Re: Distinction of PT - August 1, 2005 7:28:00 AM
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JLS_PT_OCS
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Mark-
It's called "Physical Therapy".
See this:
http://www.rehabedge.com/ubb/ultimatebb.php?/ubb/get_topic/f/25/t/001765.html
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Distinction of PT - August 1, 2005 2:14:00 PM
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interstella
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From: UK
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Hi Mark
Physical therapy's distinction is its approach to the rehabilitation of movement, which incorporates knowledge of the patients pathology with a holistic understanding of their physical, psychological, social and environmental factors.
Check out
Cott CA, Finch E, Gasner D, et al (1995) The movement continuum theory of physical therapy. Physiotherapy Canada 47:87-95.
Best wishes
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Re: Distinction of PT - August 1, 2005 5:21:00 PM
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vt2c1ms
Posts: 74
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From: Kansas
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I knew I should of said please don't answer "physical therapy". I was just wondering b/c I was asked from my present employer (he's an OD) what codes or services I can bill for that makes PT unique. He stated most codes in PT can be billed by several different providers. I was wanting to know exactly what a PT can do that no other provider can bill. I was looking for specific examples. By the way Jason, you seem like a very smart individual that has vast knowledge from reading all these posts. I don't even know you but admire your logic/thinking in the posts I have read.
Interstella, thanks for the kind reply.
Mark
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Re: Distinction of PT - August 1, 2005 5:42:00 PM
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eam
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Only physical therapists can bill for physical therapy as far as I know!!!! We can always turn this question around and ask what distinguishes other therapy providers from PT's. Can PT's only bill for "Neuro MM Re-ed", "Manual Therapy" or "Joint Mobilization"? These are generic billing codes and shoud be treated as such. It is how you apply these codes that's what makes one unique.
Erica
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Re: Distinction of PT - August 1, 2005 5:47:00 PM
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Jon Newman
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Mark,
My understanding is that only PT eval and PT re-eval are 'unique to PT' codes. All else is up for grabs.
But even that is open to debate. I think MD's can code a PT eval in some circumstances. I'm not sure which circumstance those would be however.
jon
_____________________________
[URL=http://www.sonymusic.com/clips/selection/30/064887/064887_03_03_30.wav]Evidence[/URL]
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Re: Distinction of PT - August 1, 2005 6:11:00 PM
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drbuddy
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Codes are not based on professions, but services performed. So, if a particular service is within the scope of a particular practitioner, it is reasonable to say that they can bill for those codes. However, some insurance companies may choose to pay certain codes for certain practitioners. Medicare is an example, paying chiropractors only for CMT and nothing else (not yet anyway).
Your original question is a good one. I am often asked what makes me, a chiropractor, different from a PT. It's not always an easy answer since I use many methods also used by PTs. I dont think it will get any easier over the years either. With both professions seeing a similar patient base and both professions working towards an evidence based model of care, it's only natural that we will meet somewhere down the road.
To me, what makes PTs different is the types of cases seen by you. I would never try to retrain gait in a person with a stroke, or attempt to work with a child who has CP. I also try to stay away from post operative weakness and complications (other than spinal related). I dont do wound care either. I guess what I am saying is, I feel that PTs are better equipped to handle the special needs population, especially when it comes to extraspinal conditions.
Also, sorry to go off on a slihgt tangent here, but I see little reason why PTs should worry about chiros in general. You guys have it great. You are a part of the system and are on the radar of most MDs and DOs that need to refer patients for manual therapy and rehab. As a chiro, I basically just see the people who either dont get results with PT, or who fall through the cracks. I see the people who are not quite bad enough to get that extra referral to PT, but bad enough that their quality of life is suffering. I also get people who refuse to go to the MD for anything.
Going off on even more of a tangent, I wish I could refer patients for PT. I really dont have time to provide adequate rehab and it would be great if I could refer directly. However, in PA, that is not written into law and even so most insurance companies would probably deny it anyway.
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Re: Distinction of PT - August 1, 2005 6:24:00 PM
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vt2c1ms
Posts: 74
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From: Kansas
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drbuddy,
Chiros treat backs, PT's treat bodies. Is that a fair assessment?
If you don't mind, I'd like to ask you a question. If you had to mentor a student or perhaps your son, and he asked you whether to become a DC or a DPT(you almost have to become a DPT now if you want to be a PT) then what would you tell him and what reasoning lies behind your answer? Maybe that is the best way to distinguish a DC versus a
DPT. Thanks for your answer.
Mark
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Re: Distinction of PT - August 1, 2005 7:04:00 PM
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drbuddy
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Maybe a bit of a loaded question, but I'll do my best.
As a chiro, I feel most comfortable treating spinal conditions. By spinal conditions, I mean discs, sprain/strains, stenosis, postural syndromes, etc. and not spinal cord injuries, MS, etc. However, I feel that as a chiro, I not only look at the spine, but other factors such as nutrition, ergonomics, posture, ALDs, etc. So, no, I do not feel that I just treat backs, but people.
If I had a son, assuming I did not have a busy practice to hand down to him, I would probably tell him his safer bet is the DPT. Quite simply there are more options available to DPTs. They can work for a clinic, hospital, or branch out on their own. Plus, it's sad to say, but the APTA seems to be doing a better job than our splintered groups of orgaizations. When I read about the description of DPTs, it looks very similar to what I've been taught in chiro school. We're dropping the ball on becoming primary care for musculoskeletal conditions (where MDs and DOs usually are weak), and PTs are taking it and running away with it.
For my career and my situation, the DC degree was a better fit for me. In undergrad, I was pre-PT getting ready to head on to Thomas Jefferson but I changed my plans. Why? Here's a few reasons. Please note that these apply to my state and local area and may not apply to DCs vs. PTs across the board:
- autonomy, as a DC I call the shots with my patients. I do not rely on MD scripts and no one but me makes the decision on patient care.
- autonomy, as a DC it was easier to establish my own practice and not have to rely on referrals from MDs
- diagnosis, despite what some say, my school gave me enough education to make a basic diagnosis and rule out conditions that warrant medical referral. As such, I can see people off the street and feel comfortable treating them without needing a referral to an MD for a diagnosis. I can order tests as I need to and make referrals to orthos, neuros, and family docs when I need to.
- holistic care, my DC education gave me enough background to discuss basic nutrition and identify problems in patient's diets that may be contributing to chronic pain. I can also give them basic advice on how to lose weight and take some stress off their musculoskeletal system. I also look for factors contributing to their problems such as repetitive stress at work or during ADLs, sleeping improperly, working out incorrectly, etc.
- more one on one time with patients, I schedule the way I want and I make sure I spend enough time with my patients. In a rehab clinic, as I have spent close to 100 hours observing for PT school, that was not always the case. This is also one of the reasons I decided against med school.
-other reasons for not going to med schoool, I didnt want the stress of long hours, being on call, extra years of school, high malpractice premiums, and not being able to spend enough time with patients.
- more authority, my pts see me as a "doctor". Of course this may be true with the DPT degree, but for now, I'm not sure if that is the case. I am out in the boonies in PA, so I've never even met a DPT.
By the way, I am not here to start a pissing contest with anyone. I like this site because it offers a different perrspective on some of the things that I was taught in school. I have repsect for PTs and do not wish to cause problems. Heck, my mom's a PTA and I've observed PTs for hundreds of hours while I was in highschool and undergrad.
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Re: Distinction of PT - August 2, 2005 3:30:00 AM
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JLS_PT_OCS
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drbuddy-
I fail to see how anyone could take offense at your very polite and even-handed post.
Welcome to the site, I'm glad you're here.
I am sure you have a very valuable perspective on things.
Mark-
Well, my response was in reference to your "bill for" statement. Hope I didn't come off as a smart aleck, though I've been called worse.
I would agree with the others in that it is the philosophical and scientific base you come from, more than the tools you use, that sets one profession apart from another.
I agree with buddy, and think that were a good chiro and a good PT to work together, you many not be able to tell the difference between them. I think having many professions able to do similar things is good for consumers. It really helps distinguish individuals and individual professions by evidence and performance instead of by legislative fiat. Except in Arkansas.
:)
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Distinction of PT - August 2, 2005 6:27:00 AM
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vt2c1ms
Posts: 74
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From: Kansas
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Thanks drbuddy, don't worry about a pissing contest---me and Jason got your "back"! Jason, no offense taken. Thanks again for the honest replys.
Mark
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Re: Distinction of PT - August 2, 2005 7:06:00 AM
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drbuddy
Posts: 429
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From: Pennsylvania
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Thanks guys. I just know how it can be over at chiroweb sometimes, and I'd hate to see a good discussion go to the way side like they often do over there.
Also, I've notived that DCs get a bad rap on this board, and I cant say that I blame you. I also cringe when I hear DCs treating people 3x/wk for months on end, claiming it is great for this, that, and the other. I also can't stand to watch a DC at a screening in a mall, but I've never really seen that where I work, but in a metro area (more competition I guess).
Just remember, you always notice the 20% of the whackos that stand out. They stand out because they use questionable marketing, or maybe a pt you've seen was to one and didnt get better, or they post on chiroweb and make an ass out of themselves. All the while, the other 80% of us quietly go along, doing our jobs, trying to do the best for our patients and practice as ethically and morally as possible.
Ok, I've hijacked this thread enough. If we wish to discuss this subject further (or if others have a response), please start a new thread. Otherwise, I wont mention another word in this thread and let you guys get back to the original question, what makes PT different from other professions.
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Re: Distinction of PT - August 2, 2005 7:32:00 AM
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JLS_PT_OCS
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From: USA
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drbuddy-
I don't blame you for feeling that way about chiroweb, I left for that same reason.
We have several excellent DCs who post here, giving us a good outsider's insight into our own profession as well as exploring other issues. I have really enjoyed their contributions and look forward to reading yours as well.
I think we have covered a lot of those DC/PT issues before, you might be interested in these:
http://www.rehabedge.com/cgi-bin/ultimatebb.cgi?/ubb/get_topic/f/25/t/001693.html
http://www.rehabedge.com/cgi-bin/ultimatebb.cgi?/ubb/get_topic/f/25/t/001577.html
http://www.rehabedge.com/ubb/ultimatebb.php?/ubb/get_topic/f/10/t/000083.html#000000
Although I have been one of the outspoken skeptics of your profession as a whole, I try not to let it bias me, as I have met many excellent DCs as well.
I try to focus my criticism on Chiroprac-TIC, not individual Chiroprac-TORS.
All-
I rather like that PT has many tools in common with other professionals. It really forces us to distinguish ourselves in ways other than the use of a certain tool.
That's where the excellence in practice, education, and research come in...
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Distinction of PT - August 2, 2005 7:47:00 AM
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KIDPT23
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Another problem with our field/profession that the APTA should be correcting instead of the huge push for DPT. We have these codes that are so universally used its ridiculous. It just adds to our issues with reimbursement as well. All codes we use should be unique to us as physical therapists/assistants only. It makes no sense that other health care practitioners can use codes that are specific for physical therapy. It really is a good question that started this thread. What makes us so distinct or unique? I believe we are a vital component of the overall team that rehabilitates a patient from initial injury phase to the level a patient becomes independent in their HEP with education in future prevention. I guess the answer might be found if we looked at it from a perspective of if we were absent from the team approach, what would be different,lacking, and how would a patient's progress be different?
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Re: Distinction of PT - August 2, 2005 9:39:00 AM
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drbuddy
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Again, codes are not dependant upon the profession, but rather procdures performed. The exception is the OMT and CMT codes, which describe chiro and osteo manipulations. Also, now that I think about it, there are PT eval codes. Someone mentioned that an MD might use the PT eval codes under special circumstances, but I dont see how that can be the case. Any evaluation they would perform would follow under the physician level E/M codes.
Like I mentioned above, it is my feeling that PTs are much better at handling special needs patients with neurological, developmental, and other complications. You asked what would be lacking if PTs were absent from the healthcare team. I think we would be missing vital care provided for patients after post-op, severe injuries requiring significant rehab, and other special needs patients.
Similarly, if DCs all of a sudden vanished from Earth, people with less complicated acute and chronic musculoskeletal conditions would have no place to go. I find that these patients are most often told by MDs to take some meds, rest, and ice if needed. They are never referred to PT unless they are persistant and keep returning to the MD and/or ask directly for a PT referral.
In my opinion, you guys are better off if you stick with the team approach treating patients within the system. It seems like with the new DPT degree, PTs want to branch out on their own and become more autonomous. I'm not sure why you would even want direct access. Why take yourself out of that loop?
To go back with what makes us disctinct from one another... perhaps we are looking at this all wrong. Maybe we shouldnt distinguish ourselves by the procedures we use, but maybe the difference is the types of patients we see. I just spoke with my mom, a PTA, and asked her about the patients see saw this morning. Most were either extremities, post surgical, or post stroke patients. She works for an independant PT working out of his own office. Contrast this with my patient load yesterday afternoon (gave myself off this morning), most patients were either spinal, a few sciatic and disc pts, and the other non-spinal complaints were very chronic in nature that havent responded to care of any kind and have been present for over a year(I get a lot of those).
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Re: Distinction of PT - August 2, 2005 10:38:00 AM
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curio
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PT's see a multitude of patiets with a wide range of diagnoses..upwards of 750,000 patients seen daily in the U.S.. As far as your caseload Drbuddy, I can say that its very similar to mine...at least 50% of my patients are acute to chronic LBP with everthing from derangent to s/p sx, to dysfuction..and I use and bill for manipulation/mobilization of the spine...when its called for in my professional judgement...not that often actually..but its just one tool... Again, I would like to say that having DC's on this forum is great...most are responsible healthcare providers, but its the minority that seems to make my traps seize! :) Such as attempting to limit P.T.'s scope of practice...
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Re: Distinction of PT - August 2, 2005 10:38:00 AM
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JLS_PT_OCS
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The DPT and direct access aren't about getting out of the loop, drbuddy.
It's about having fewer roadblocks to provide the best care for patients, among other things.
It's also about preserving our right to practice the way we historically have and broadening our capacity to do so in the future.
Your afternoon sounds like mine!
And if we are seeing "off-the-street, no referral" patients, I wonder if PTs would be any good at that type of work?
In fact, there's some evidence to say that only Orthopedic surgeons are better at primary care type musculoskeletal medicine than we are:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15963232&query_hl=4
So it seems we are eminently qualified to do the kind of work we currently do, and to continue to fill a niche in the world for what seems like an endless stream of musculoskeletal dysfunction in the outpatient and active population. The DPT and direct access just removes artificial barriers to our doing that. And allows us to better thwart those that would have a monopoly (eg Arkansas).
I think our distinction as PTs would be our unique combination of "the science of healing, the art of caring" and our hands-on approach.
Though certainly we share many aspects of our practice with others, I do not believe any of those others have such a strong background in Education, Practice, and Research.
As a profession, I mean, not individuals.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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