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When to discharge in Outpatient?
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When to discharge in Outpatient? - July 18, 2006 8:04:00 AM
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cowboybuboy
Posts: 51
Joined: June 15, 2005
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I'm pretty new in outpatient setting and I apologize for the dumb questions that will follow. Just wanted to know when do we discharge patients from outpatient?
Is "maximum potential reached" enough reason to discharge a patient? If a patient is not improving for 1 month, or at least doesn't have significant improvement in 1 month, is it reason to discharge? If pain keeps coming back and you think physical therapy is not helping, is it reason for discharge?
Thanks to all!
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Re: When to discharge in Outpatient? - July 18, 2006 1:10:00 PM
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SJBird55
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From: Michigan
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I hate to laugh at you, but I'm actually laughing at you! Remember when you asked some question about an MD partnering with you? Ummmm, I believe you are a perfect candidate in an MD's mind in light of the above question - if you don't know when to discharge a patient, you can be an awesome revenue generator for a physician!
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Re: When to discharge in Outpatient? - August 15, 2006 11:06:00 PM
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rv36116
Posts: 216
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From: Texas
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wow there SJ... nice and easy with folks asking questions who preface it with "I'm pretty new to outpatient"... Sheesh.
Cowboy, what type of therapy were you concentrating in before starting outpatient. Just wanted to get a grasp on where you're coming from before answering.
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Re: When to discharge in Outpatient? - August 16, 2006 1:57:00 AM
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Sebastian Asselbergs
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Joined: September 29, 1999
From: Barrie, Canada
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Cowboy - that stuff should have been covered quite extensively in your clinical placements and at school! Absolute basic stuff. Really. Think about the issues at hand - professional standards of practice, and then look at your questions - give "yes" answers, check the standards, the give "no" answers and check again. You will have a clear pic ofwhat the right answers are. And try to get a refund for tuition! You are a brave cowboy to post your question! Kudos for that.
_____________________________
Mundi vult decipi
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Re: When to discharge in Outpatient? - August 16, 2006 2:27:00 AM
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SJBird55
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From: Michigan
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Rob, I'm really not that cold toward others. If you weren't following along back in July, then you don't know what else was being posted at that time. Cowboy had another question about partnering up with an MD and providing services in a physician owned clinic. There are obvious problems in any referral for profit situation. But then, when cowboy posted this question, it really was funny to me. He'll be the perfect candidate for a referral for profit situation - the MD will tell him that he needs to continue PT and cowboy will go along and continue PT without clinically assessing the situation and the MD will make more and more revenue. Inherently, in posing the question, cowboy obviously runs the risk of overtreating based on the simple fact that the MD said it was needed AND the MD was his boss.
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Re: When to discharge in Outpatient? - August 16, 2006 3:56:00 AM
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ehanso
Posts: 355
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From: Minnesota
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Pretty straight forward actually. Have they reached maximum benefit from treatment? Is what you are doing medically necessary? If there has been no improvement in symptoms in the last couple of visits and they are returning to previous activity levels, it would be insurance fraud and unethical to continue with treatment.
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Re: When to discharge in Outpatient? - August 16, 2006 6:14:00 AM
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Shill
Posts: 1098
Joined: February 13, 2003
From: Madison WI USA
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The answer is generally yes to all of your questions, (could be two weeks, instead of a month, depending on condition) aside from the first one. To answer that, these will work.
When they no longer need your SKILL to make further recovery. When they can do for themselves everything you are doing for them. When they have achieved the goals set for them, or their personal goals. If they are no longer making functional gains, or gains towards functional gains, in a reasonable amount of time or visits. Whats reasonable? Check the guide to PT practice.
that should help some, right?
_____________________________
Steve Hill PT
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Re: When to discharge in Outpatient? - August 16, 2006 11:16:00 AM
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jbird007
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From: USA
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With some insurance cases, some patients fall into a catagory of MMI with maintainence care.
Jbird
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Re: When to discharge in Outpatient? - August 17, 2006 5:31:00 AM
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rodgere
Posts: 49
Joined: June 2, 2004
From: Linden
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ok some of you guys up there need to relax. This is a very good question.
if you want to impress the docs then fix them in 3-4 visits. what the mds don’t want (im not an MD) is a letter that you have worked on the patient for 12 visits with no daily treatment assessment or reasoning to continue. The last time an MD complimented me was when i d/c a patient on day one b/c there were no changes via mechanical evaluation. im not saying to dicharge everyone in 3-4 sessions but as stated above you should have something good to say about their complaints on the 3rd or 4th session (Maitland vertebral volume 6). also stated by (FallsPT)
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Re: When to discharge in Outpatient? - August 17, 2006 6:49:00 AM
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srcase
Posts: 551
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From: Michigan
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Just a few additional thoughts:
You should be planning when to D/C at the first visit: writing in your plan a specific timeline.....4-6 weeks, etc.
You should D/C when the patient no longer needs skilled PT, and can continue to improve with just strengthening or HEP.
You should D/C if the patient has not demonstrated progress toward any of the established goals in a reasonable amount of time.
You should D/C if the patient has met 80% or more of long-term goals (guideline).
cowboy, I think you have a very legitimate question here and depending on the type of clinic you practice in, you may not have much support for D/Cing patients. I've worked at clinics where patients stay for 6 months and get the same treatment every visit.
Sarah
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Re: When to discharge in Outpatient? - September 20, 2006 12:05:00 PM
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bomas52
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I hate to be late to the party, but I just noticed this thread. I work in the insurance industry as a PT case manager and all of the above are the right reasons for discharge. Unfortunately, too few therapists choose to apply these criteria on a regular basis. The one that really makes me cringe is when I am reviewing a case and the therapist writes "will continue current course of treatment if insurance approves". Obviously, that therapist doesn't feel very strong about the benefit of the care being provided.
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Re: When to discharge in Outpatient? - September 21, 2006 7:38:00 AM
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Shill
Posts: 1098
Joined: February 13, 2003
From: Madison WI USA
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Bomas,
What you state is true, unless the quoted statement occurs on visit #2. There are some insurances that approve evaluation only, and then require approval of POC to continue. Given that most of us work in busy clinics, this results in unnecessary wait and lag time between evaluation and start of treatment. Hopefully, you work for a reasonable company that doesnt get too crazy about limiting the patient visits to an unrealistic number.
_____________________________
Steve Hill PT
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