Sorting the boundaries around direct access (Full Version)

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Diane -> Sorting the boundaries around direct access (April 5, 2005 9:46:00 AM)

I can't move significant threads into this new forum, but I can post a link to old threads that are pertinent: here's a link to the topic as it developed in Open Forum a few weeks ago:
[URL=http://www.rehabedge.com/ubb/ultimatebb.php?/ubb/get_topic/f/25/t/001540.html]direct access states[/URL]

In wake of recent discussions about PT direct access on the Chiro Demonstration thread, this one may revive.



David Adamczyk -> Re: Sorting the boundaries around direct access (April 5, 2005 10:33:00 AM)

Hi Diane,

I was able to move the thread into the Private Practice / Business Development Forum. It is about six topics down from the top.

Thanks!

Michelle Adamczyk
Director of Marketing
[URL=http://www.RehabEdge.com]www.RehabEdge.com[/URL]



Diane -> Re: Sorting the boundaries around direct access (April 5, 2005 10:34:00 AM)

Oops! Thanks!



Diane -> Re: Sorting the boundaries around direct access (April 5, 2005 3:09:00 PM)

I thought it would be good to move the debate on direct access to here. Much of it was on the chiro demo project thread in open forum, so here is a link to refresh the memory, in case anyone would like to take the discussion on direct access for PT in a new direction in this thread.
[URL=http://www.rehabedge.com/ubb/ultimatebb.php?/ubb/get_topic/f/25/t/001577.html]chiro demo thread[/URL]



Diane -> Re: Sorting the boundaries around direct access (April 12, 2005 5:27:00 AM)

Here is the 'medical Dx versus PT Dx' thread from open forum:
[URL=http://www.rehabedge.com/ubb/ultimatebb.php?/ubb/get_topic/f/25/t/001607.html]"Medical" diagnosis? Isn't PT diagnosis good enough?[/URL]
I brought it here because of its private practice implications.



hmgross -> Re: Sorting the boundaries around direct access (April 12, 2005 6:30:00 AM)

Thanks Diane. I always thought this "medical" diagnosis vs "PT" diagnosis thing was very confusing. As you know, I have to come up with something to put it that box on the 1500 form in order to get paid. I was told once to stay away from diagnosing anyone as an "-itis" because that is practicing medicine. I can't remember who told me that a PT in Minneapolis several years ago got in trouble for diagnosing a patient as having shoulder bursitis, or maybe it was tendonitis.



SJBird55 -> Re: Sorting the boundaries around direct access (April 12, 2005 7:34:00 AM)

I have found it completely confusing too. We have to diagnose what we think we're treating. Where does medical diagnosis end and physical therapy diagnosis begin and what if they both are the same diagnosis? Heck, I haven't even seen a definition for "medical diagnosis." I'd love to hear from someone in a direct access state that has a clause regarding the fact that they have direct access but they can't "medically diagnose." What happens? How do you know that you aren't medically diagnosing? And, how does your regulating board determine if something is a medical diagnosis or not? This would never happen, but if someone was carried in off the street in need of care and they had a piece of tibia sticking out of their skin, well, that would be a fracture and would need to be referred out... is that a medical diagnosis?



Sebastian Asselbergs -> Re: Sorting the boundaries around direct access (April 13, 2005 2:02:00 AM)

Diagnosis: "description of the nature of a disease or dysfunction following medical investigation" (Coelho)

Diagnosis: "the recognition of a disease from its symptoms// a formal statement of the decision reached in identifying a disease" (Webster's)

The difference between PT and MD is of course the scope of practice. Ours is much more limited and thus our (potential) diagnoses. The fact that I call it "conclusion", is only to mollify those MDs who have trouble with me using the word "diagnosis". Most, however, have been more and more amenable us diagnosing in certain areas: I get more referrals with "assess and treat please" with the expectation that I will report back on what my findings are. It has been many many years, since I have seen a referral with ANY prescription of WHAT to do; compared to the early 80's, when I received very exact (and bad) referrals on what the patient had, what I was supposed to do with them, and for how long.
If that can change (a decades long subservient relationship), I think the diagnosis issue can change too. As long as we use it within our scope, and when we disagree with the referral source's diagnosis, find a way the show WHY we disagree. I always quote the tests that make me come to a different conclusion than the referral source - if necessary, I use references about new studies on certain tests (e.g. "empty can"). It is OUR job to do it right, and I do not think we can expect MDs to do anything to help us. And they shouldn't really. It is our issue, we have created it mostly ourselves by being technicians for so long; we need to bring ourselves to the level we know we can attain in the health world - this is not the MDs responsibility. I can understand the reluctance and resistance they have to us using the word "diagnosis" - look at how we react when massage therapists use the word "mobilisation" in their scope of practice.

I agree SJ, the separation between "medical" and "PT" diagnosis is more confusing than helpful. We certainly need to be in on the discussions of all the PT-regulating bodies when this subject comes up.



FLAOrthoPT -> Re: Sorting the boundaries around direct access (April 13, 2005 4:40:00 AM)

i try to use the word clinical impression. I stay away from diagnosis. Even though our clinical impression is usually much more thorougg than what the MD uses to call their diagnosis, I still will stick with impressions, and dysfunctions and describe the problem some rather than try to name it. For example...I will not say patient has bursitis, but call it: Shoulder pain secondary to restricitions in the inferior and posterior capsule mobility and scapular weakness with anteverted scapular causing superior and anterior migration of the humeral head during overhead motions which may be causing impingement of supraspinatus and bursae. (then go on to say that patient will benefit from capsular mobilizations, stretching, scap stengthening, postural modification, modalities as needed for stretching and reducing imflamation....etc, etc, etc...) The only place I code a diagnosis is on the 700 form. And I make sure it is scoded the same as the MD. So if the MD says bursitis and it is labral tear etc, I'll still put bursitis on the 700...



Diane -> Re: Sorting the boundaries around direct access (April 13, 2005 7:55:00 AM)

I love that 50-word "impression" FLA, yet that is what we work with. Try coding something like that!

We are adept at working with impression, what I call the non-pathological grey zone. Yet we appear to get less respect instead of more for that capability.

I think we should stop trying to get respect via insurance. We should wean off insurance, or insurance will wean us off itself. Insurance should be there for pathology that's definable and based on reality. It should be in place for a ruptured aorta, a fracture, a cancer. It needn't be there for mythical subluxations (in the case of chiros) or a pain in the whatzit.

Most pains in the whatzits aren't pathological. PTs are specialized to sort out what we can treat/fix/coax the patients' nervous systems to fix, and what we can't. Our professionally installed detector system goes into red alert when something seems funny or doesn't respond to what we do, and we get it out of our office into a medical one.

We have different poles of tension operating on us as we evolve our profession in various regions round the world:
1. A mindset of financial dependancy on insurance coupled with varying degrees of lack of direct access in some geographical areas;
2. Emergent status as a stand alone health profession in others, outside or inside of insurance parameters, with or without direct access, freely moving between public care and private care, institutions and free standing private practices.

Direct access, cash practices and self regulation by PTs will go a long way to eclipsing CAM, by offering an "alternative" that is less anti-medical, more convergent, more rational and consistant with science.



FLAOrthoPT -> Re: Sorting the boundaries around direct access (April 13, 2005 4:04:00 PM)

agreed...haven't taken insurance in over a year and have been a lot happier and a lot wealthier..can care less about cpt or icd-9 codes these days



Randy Dixon -> Re: Sorting the boundaries around direct access (April 13, 2005 11:41:00 PM)

I wonder if the fact that PT is more than OP PT makes a difference in perceptions and in achieveing DA. Chiropractors, for example, never worked in SNF's, inpatient hospitals, hospices etc.

Strangely, those settings seem to be where DA is already allowed.



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