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Subacromial decompression
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Subacromial decompression - August 27, 2007 3:15:47 AM
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goodlooks58
Posts: 430
Joined: October 21, 2002
From: CA
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There is this new hot shot ortho in my bldg. In 2004 he was good as there were no problems with his surgeries. Last year he has become greedy, has an ATC in the office and calling it POPT without a PT. Also since last year I have seen 3 post-op subacromial decompression and they all have failed as the pain is still intense after 9-10 weeks especially from 90 to 120 degrees in elevation. What can I do to improve my outcome as he is putting the blame on PT (i.e. my care). What is the general protocol for the above mentioned dx? Same dx from other orthopods, the pts. are all better and I have advanced them to almost independant ex. Need help. Thanks.
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RE: Subacromial decompression - August 27, 2007 8:08:58 AM
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orthotherapist
Posts: 219
Joined: February 6, 2007
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When are you getting these patients? Do they go to the ATC first and then come to you once they begin to have problems or are they with you from the get go? Obviously you know what you are doing if your other SAD from other orthos are getting better
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RE: Subacromial decompression - August 27, 2007 11:15:10 AM
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VagusX
Posts: 220
Joined: March 26, 2003
From: Savannah, GA, USA
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Tough situation because you don't want to burn a referral source, but getting your a$$ chewed just isn't right. I would try to talk to the doc to see if he can send directly to you instead of through the ATC, although that may be unrealistic due to this guy sounding like a greedy idiot.
As far as the protocol, I would treat it similiar to impingement cases.
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RE: Subacromial decompression - August 28, 2007 12:39:55 PM
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USAPT
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how do other post-op pts from him perform? Have you seen a change in them as well?
Were the 3 SAD pts back to back or signif time in between? Reason being, it may just be those pts. You would expect the SAD post-op pt to be an 'easy' rehab as there is no real protocol..ROM to tolerance. I've seen some do well and others do poorly. Also, consider what your pts are doing at home.
As stated above, are the pts going to the ATC first? If so, there's your argument against your outcomes. Have MD send them to you directly...as it should be.
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RE: Subacromial decompression - August 28, 2007 8:38:18 PM
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Kaden
Posts: 346
Joined: June 17, 2007
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The other thing you may question is patient selection. Do these patients have any underlying cervical dysfunction leading to sub-acromial impingement and thus are not seeing the results. A lot of SAD done that are unsuccessful are usually the result of some other dysfunction causing the shoulder pain in the first place and the patient therefore was not a good surgical canidate.
There may be evidence of AC joint pathology and decreased joint space but this does not necessarily mean there pain is coming from the shoulder.
Just a thought.
If no cervical dysfunction type issues going on then I agree with the others who say to continue to treat how you have done previously with good results.
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RE: Subacromial decompression - August 29, 2007 1:02:30 AM
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goodlooks58
Posts: 430
Joined: October 21, 2002
From: CA
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Sorry, I was not clear in my post: The patients he sends me have not been to his ATC. And yes, 1 pt I thought had a cervical disc invlovement, however, her MRI was -ve and moreover the second MRI showed a RTC tear in the same shoulder. Can ATCs work in an orthopod's office and call it physical therapy?
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RE: Subacromial decompression - August 29, 2007 8:16:51 AM
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orthotherapist
Posts: 219
Joined: February 6, 2007
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With incident to billing ATCs/massage therapists/exercise physiologists may all work ini this setting - they can not see medicare but all other insurances as far as I am aware are free game. The physical therapy evaluation code may not be utilized but all other codes can be.
As far as calling it physical therapy I do not think they can do that although practice acts vary. They can call it physical rehab etc. I have seen insurance companies around my area that now require only a licensed physical therapist (not even an assistant) see the patient. My guess is they are trying to avoid paying for physical therapy when it is not rendered by a therapist.
As far as I know it is perfectly legal and more common than we think. I have even run across clinics in the past that employed a "physical therapist" - even went as far as listing where they graduated from etc. Only problem was they did not have a license either because they were from out of the country or had faileed the board exams too many times.
I have personally worked with several ATCs that are now "physician extenders" as they like to call themselves. They do "rehab" in addition to a multitude of other services that may encroach on a physician assistants turf.
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