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Re: Appropriate Referrals
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Re: Appropriate Referrals - January 25, 2006 4:56:00 PM
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TMondale
Posts: 131
Joined: January 3, 2005
From: Newton-Wellelsley Hospital
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GLASGOW,
Again you're going to have to define full diagnostic status. If you mean direct access, most PT's have that already. If you mean we can't order diagnostic tests, I suggest to you that if we fail to recognize a case that requires further diagnostic work-up we are absolutely culpable. If we make a decission iether by referral or DA, we are 100% responsible for the possible consequences. It's true now, and it will be true when DA becomes more the rule than the exception.
It has always been my beliefe that PT's are the experts of choice for care of psycho-neuro-musculoskeletal system as it relates to pain and function and we should present ourselves as such. With this in mind I don't have any problem with Chiro's learning from us if they are interested in learning. They are competition but I don't believe they are anywhere near our biggest problem.
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Re: Appropriate Referrals - January 25, 2006 6:41:00 PM
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james097
Posts: 178
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From: West Vancouver BC
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Dr. Buddy says "I think PTs do have direct access in PA. We traded that for the right to remain the sole providers of spinal manipulation".
Tell me this isn't so. If it is so it speaks volumes for the state of PT at least in PA.
Now, if a patient self refers to a PT and has no script the PT will not be paid by insurers anyway. Some trade off, some gain. Now I understand the true meaning of a pyrrhic victory.
Jim McGregor
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Re: Appropriate Referrals - January 25, 2006 8:23:00 PM
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michaelemery
Posts: 4
Joined: January 8, 2006
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quote:
"get a clue and develop a better market strategy or else they will end up as MD/DC aids"
I work for a major health care provider and our physical therapy referrals exceed our staffing capacity. We did post 4 P.T. job openings. We did also fill two slots, giving each new hire a nice 5000 dollar sign on bonus. Our cont'd referral projections indicate a linear rise in therapy utilization, and we are trying to hire two more P.T.'s in preparation for this.
In other words, I'm not worried about job security and ultimately becoming a DC aide, despite the ongoing PT vs DC turf wars.
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Re: Appropriate Referrals - January 25, 2006 8:32:00 PM
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michaelemery
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quote:
I have no doubt which profession is leading the world in excellence in research, practice, and education in nonsurgical musculoskeletal care. It's us PTs.
Agreed. P.T. research is not 'loaded' for backdoor marketing.
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Re: Appropriate Referrals - January 26, 2006 2:27:00 AM
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dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
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Todd,
I hear you and agree that in some aspects PT's do tend to educate to broad an audience, I think that teaching a continuing ed course that includes evaluative techniques, manipulation techniques and the like and allowing LMT's, ATC's, PTA's to attend is irresponsible, not because I am afraid of loosing business to these groups but because we are training these folks to do things they are not liscensed to do. i feel it creates a public saftey risk at the worst end of it and at the least end of it, a waste of healthcare dollars for the people who end up having an LMT attempt to do rehab because they spent a weekend in a course learning about MFR for whiplash or something of the sort.
Is this more towards where you were leaning with your original post?
Rick
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Re: Appropriate Referrals - January 26, 2006 3:06:00 AM
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TMondale
Posts: 131
Joined: January 3, 2005
From: Newton-Wellelsley Hospital
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James,
I don't work in PA, but I've certainly never heard of it as a state that does not have the ability to manipulate within their practice act. Not sure what buddy is talking about there.
Tim
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Re: Appropriate Referrals - January 26, 2006 3:15:00 AM
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drbuddy
Posts: 429
Joined: July 30, 2005
From: Pennsylvania
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Yeah, I wasnt sure about that. I guess there is no limitation from what I can gather in the practice acts.
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Re: Appropriate Referrals - January 26, 2006 7:33:00 AM
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GLASGOW
Posts: 91
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Arkansas for example.
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Re: Appropriate Referrals - January 26, 2006 8:13:00 AM
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paulpt
Posts: 164
Joined: May 31, 2005
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Glasgow, you are right about Arkanas... and for those who wish to know more about that, use your internet search tool to find out more.
PA did recently get 'direct access' but it has limits... you can treat a patient for 30 days without the referral from the 'doc'. Prior to this, they were eval but no treatment without a referral.
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Re: Appropriate Referrals - January 26, 2006 8:35:00 AM
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drbuddy
Posts: 429
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From: Pennsylvania
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In states with DA like PA, do ins companies still require a script for reimbursement?
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Re: Appropriate Referrals - January 26, 2006 9:05:00 AM
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paulpt
Posts: 164
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drbuddy - that is a yes for many. In Maryland, BCBS just dropped the requirement for _some_ of their plans. I am in Maryland now, and dont know exactly how the compadres from my former state are faring with this.
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Re: Appropriate Referrals - January 26, 2006 11:16:00 AM
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jbauer24
Posts: 9
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Hello all:
Drbuddy is right, PT's did trade direct access for spinal manipulation in PA. Seems like a fair trade given that manipulation is probably a very small part of the PT practice but direct access is a big win.
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Re: Appropriate Referrals - January 26, 2006 12:54:00 PM
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dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
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jbauer, I bet Mr. Teston would disagree with you, as do I, depending on how the practice act defines manipulation. A very slippery sloap to loosing the right to perform ALLL manipulation, including soft tissue, extremity.
Rick
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Re: Appropriate Referrals - January 26, 2006 1:10:00 PM
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TLB
Posts: 353
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From: Arizona
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[QUOTE] I hear you and agree that in some aspects PT's do tend to educate to broad an audience, I think that teaching a continuing ed course that includes evaluative techniques, manipulation techniques and the like and allowing LMT's, ATC's, PTA's to attend is irresponsible, not because I am afraid of loosing business to these groups but because we are training these folks to do things they are not liscensed to do [/QUOTE]Rick,
Well put and yes that is more along the lines of what I was trying to express, maybe I was being to all encompassing with my first post. I think we've all or least I've sat through con-ed courses with other disiplines who I felt weren't qualified to be perfoming some of the techniques that were being taught. Although that's just one example of what I was trying to convey. Thanks for the input.
_____________________________
Todd
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Re: Appropriate Referrals - January 26, 2006 2:21:00 PM
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jbauer24
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Joined: January 23, 2006
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Rick:
I would agree with your clarifications, for example soft tissue manipulation is clearly within the PT scope. However, spinal manipulation would not fall outside the scope. Again, a fair compromise for direct access.
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Re: Appropriate Referrals - January 26, 2006 2:22:00 PM
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jbauer24
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Rick:
I would agree with your clarifications, for example soft tissue manipulation is clearly within the PT scope. However, spinal manipulation would not fall outside the scope. Again, a fair compromise for direct access.
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Re: Appropriate Referrals - January 26, 2006 3:33:00 PM
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TMondale
Posts: 131
Joined: January 3, 2005
From: Newton-Wellelsley Hospital
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jbauer24,
I find this extremely hard to believe that in the aftermath of the absolute travesty in Arkansas any state would use manipulation as a bargaining chip. There are too many good PT's in PA to allow this to be the case. Ask Anthony Delitto how important it is, according to the best evidence to be able to manipulate. We should never give up anything to anybody for any reason. That lesson has been learned enough times (Washington, Arkansas).
Tim
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Re: Appropriate Referrals - January 27, 2006 12:37:00 AM
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dosrinc
Posts: 335
Joined: December 9, 2004
From: Bonita Springs
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jbaur, the problem becomes evident in the Arkansas case, first you say ok we will give up spinal manipulation, then the chiros send in some sham pt who tells you his Tspine hurts you do a simple thoracic extension mob, non grade 5 that is done in a manner similar to a technique a chiro may use, the guy hears a pop, next thing you know youve got a 10k fine from the chiro state board, we should never, ever give up something with so broad a definition.
rick
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Re: Appropriate Referrals - January 27, 2006 3:22:00 AM
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jbauer24
Posts: 9
Joined: January 23, 2006
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Tim:
I understand what you are saying, but direct access is a big win and if you are trying to eliminate opposition politically, sometimes you have to give up something. Would you not agree that for the long term benefit of the PT's, direct access helps expand opportunities. With all else that PT's do, that is a small compromise.
Rick, I agree that the law could be abused as it would in that scenario.
jbauer
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Re: Appropriate Referrals - January 27, 2006 4:00:00 AM
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paulpt
Posts: 164
Joined: May 31, 2005
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Bauer - obviously you do not know the definition of manipulation, as defined by the American Physical Therapoy Association... if we give up manipulation, according to the definition by the professional association, we give up ALL of it. Please use terms properly, your ability to perform passive range of motion of ANY kind could be decimated.
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