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RE: PTA's as "Therapists"
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RE: PTA's as "Therapists" - December 9, 2007 7:48:21 PM
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proud
Posts: 920
Joined: March 22, 2006
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Well I would agree that there are more important things to discuss. However, when those that carry the tittle do not seem to understand the missing {'s}, there is a potentially serious problem. Pl, I believe the crux of this thread is that the original PTA in question appeared to be confused between "Physical therapist assistant" and what the title is really intended to mean...."Physical therapist{'s} assistant".
In the original post:
quote:
...Then, during two other conversations (unrelated to the name tag issue) I heard her refer to PTA’s as “Therapists”...
When even a PTA is confused about the term "therapist" then it's inevitable that the public could become confused there. Was it reenie{?} who seems confused in saying that a PTA is a therapist "on another level". Well that is inaccurate. The two are not comparable on any level. A physician{'s} assistant is not a physician on another level....the training is less, the training is not the same with "less concentration", the examinations are entirely different and as stated, the medical-legal aspects are markedly different.
Or a legal assistant suggesting that they are lawyers on a different level....I could go on. Capiche?
< Message edited by proud -- December 9, 2007 8:03:56 PM >
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RE: PTA's as "Therapists" - December 9, 2007 8:57:05 PM
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reeniePTA
Posts: 17
Joined: October 21, 2005
From: Rochester, NY
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I think the PT's of this board are missing the point! All we are saying is that PTAs' are also therapists, we are just at a different level!!! I also tell my patients that I am a Physical THERAPIST Assistant. I also explain to them that the only thing that I cannot do that a PT does is evaluate. And in my clinic that is the way it is! I am asked to "collect" data for re-evals, I sometimes have to dictate the re-eval, I have also done discharges. Is what we learned in school as in depth as PT's..no it is not!!! But we had to show that we had critical thinking skills in being able to assess a patients condition everytime we see that patient. And when I start seeing a patient after the IE is done, that usually means I am seeing that patient a heck of alot more than the PT. And I had better be able to know when things don't quite sound right or if I feel the PT needs to see a particular pt. ASAP!!!!!!! That is all critical and assessing skills in my book.
I am sad d/t the fact that this is a second career for me and it is really disheartening that some PTs' cannot admit that a PTA is an important and critical part of the TEAM!!!! In fact it bothers me so much that I am going to be going back into my old career. Give me the corporate world anyday, I got alot more respect from my peers!!
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RE: PTA's as "Therapists" - December 9, 2007 9:20:41 PM
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proud
Posts: 920
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quote:
ORIGINAL: reeniePTA
All we are saying is that PTAs' are also therapists, we are just at a different level!!!
And that is where you seem to be confused I think. Did you read...fully, my previous posts?
quote:
Is what we learned in school as in depth as PT's..no it is not!!!
I think this statement implies that the two are along the same continuum. It has nothing to do with the "depth" of the studies.
quote:
But we had to show that we had critical thinking skills in being able to assess a patients condition everytime we see that patient.
Yes, no argument here
quote:
...it is really disheartening that some PTs' cannot admit that a PTA is an important and critical part of the TEAM!!!!
Whoa. I would like you to scroll back and find anywhere on this thread where that was implied. rehabilitation is a busy business. Many people in need. PTA's assist in implementing a treatment plan outlined by the Physiotherapist which allows more volume of patients to access rehab services. PTA's play a critical role.
quote:
In fact it bothers me so much that I am going to be going back into my old career. Give me the corporate world anyday, I got alot more respect from my peers!!
Well, I figure that is actually your problem Reenie. PTA's are critical players in healthcare. They are not however "therapists on a different level".
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RE: PTA's as "Therapists" - December 9, 2007 9:23:07 PM
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SJBird55
Posts: 2357
Joined: May 10, 2004
From: Michigan
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No, physical therapist assistants are not therapists - they are assistants to physical therapists. "Assistant" is the key word.
I'll be honest... I hardly used a PTA when I had the option. When I chose to delegate, I did the manual aspect of the treatment on each visit, I assessed the response and then I would delegate if I thought the patient was ready to have someone of lesser skills and qualifications assisting in provision of care. I only delegated when I knew the patient should have a stable, predictable response to an exercise intervention. I also never choose to do interventions that patients can do independently at home, which means skill is required in quickly adapting/progressing the program at a moment's notice and not 2 weeks later. When I did home health, I didn't use a PTA - I had patients that were unstable in their presentation.
In the orthopaedic world, I'd take a certified athletic trainer any day. An ATC has more in-depth orthopaedic training. PTA's aren't important or critical in my opinion. From a business perspective, PTA's exist so that the same CPT code can be billed out at the same reimbursement level as if a PT did the intervention and that is where profit occurs. PTA's are not paid at the same level as a PT. A PTA basically increases the level of profit due to the difference in pay. Another potential reason the PTA exists may be due to a PT shortage. The industry needs someone to do the job, so there may be a higher PTA to PT ratio currently.
Obviously, I don't value the PTA. My practice style wouldn't allow for a PTA. Frequency of visits are down to 1-2 visits/week... deductibles and co-pays have increased.... patients need a PT with the higherer level of skill and knowledge moreso than a PTA. That's just my opinion.
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RE: PTA's as "Therapists" - December 9, 2007 9:44:45 PM
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proud
Posts: 920
Joined: March 22, 2006
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quote:
ORIGINAL: SJBird55
No, physical therapist assistants are not therapists - they are assistants to physical therapists. "Assistant" is the key word.
I'll be honest... I hardly used a PTA when I had the option. When I chose to delegate, I did the manual aspect of the treatment on each visit, I assessed the response and then I would delegate if I thought the patient was ready to have someone of lesser skills and qualifications assisting in provision of care. I only delegated when I knew the patient should have a stable, predictable response to an exercise intervention. I also never choose to do interventions that patients can do independently at home, which means skill is required in quickly adapting/progressing the program at a moment's notice and not 2 weeks later. When I did home health, I didn't use a PTA - I had patients that were unstable in their presentation.
In the orthopaedic world, I'd take a certified athletic trainer any day. An ATC has more in-depth orthopaedic training. PTA's aren't important or critical in my opinion. From a business perspective, PTA's exist so that the same CPT code can be billed out at the same reimbursement level as if a PT did the intervention and that is where profit occurs. PTA's are not paid at the same level as a PT. A PTA basically increases the level of profit due to the difference in pay. Another potential reason the PTA exists may be due to a PT shortage. The industry needs someone to do the job, so there may be a higher PTA to PT ratio currently.
Obviously, I don't value the PTA. My practice style wouldn't allow for a PTA. Frequency of visits are down to 1-2 visits/week... deductibles and co-pays have increased.... patients need a PT with the higherer level of skill and knowledge moreso than a PTA. That's just my opinion.
Well SJ, I see your point. However when I worked in the U.S., I worked with some really good PTA's. When trained properly to follow through on a plan, not over-step their position( assistant is the key word). The assistant's I worked with fully understood their role and worked within that role to deliver effective....and yes...cost effective care.
Given the volume of clients in need of rehab services, I think it would be overkill to have only PT's doing the assessments and treatments. Ideal yes( I imagine outcomes WOULD be overall better), but somewhat utopian.
I would agree with you however that in a strictly orthopedic setting, I would take an ATC or Kinesiologist to assist in implimenting a treatment plan anyday. More training for sure.
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RE: PTA's as "Therapists" - December 10, 2007 7:45:44 AM
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SJBird55
Posts: 2357
Joined: May 10, 2004
From: Michigan
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No one can state that the care provided by a PTA is cost-effective. 1) The cost to the patient is the same as if it were provided by a PT. There is no sliding fee scale based on who provides the interventions and 2) there is no data to support the idea that care provided by a PTA is effective. In fact, the work done by Jensen and Resnik on "expert" physical therapists actually indicated that the "expert" physical therapists did not delegate to PTA's on a very frequent basis. Resnik's work with "expert" in the nursing profession was was indicating that the nurses with higher levels of education were more effective than those nurses with a couple year degrees. I don't know if that work has been published, but she was part of a panel a few years back discussing "expert." Interesting stuff.
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RE: PTA's as "Therapists" - December 10, 2007 6:21:36 PM
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VagusX
Posts: 212
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From: Savannah, GA, USA
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SJ
I can provide data that my PTA is effective. I hope that everybody else here can aswell. I have patient's consistently improve, month in and month out, as inidicated by OPTIMAL and other outcome measures that are treated almost exclusivly by my PTA. I can have exclusive outcomes for my PTA because she is my only aquatic "therapist." If I were to put my money on who would get better outcomes if I decided to jump in the pool, I could almost guarentee that she would kick my butt. So where does all this fall? Training. If you are good at what you do, it doesn't matter a heck of a lot what you have as credentials behind our names.
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RE: PTA's as "Therapists" - December 10, 2007 6:36:43 PM
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SJBird55
Posts: 2357
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From: Michigan
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Well, VagusX, that is good. You are only talking about one PTA in one setting - the water. What about as a whole group? Is the care provided by a PTA effective? Resnik noticed differences between PTA provision of care between a licensed PTA and a non-licensed PTA. I'm not sure if it was a statistically significant difference though and I don't believe I've seen that material published yet either... but she asks good questions.
When I looked at the OPTIMAL, I wasn't impressed. I prefer to use the PF-10 and a condition specific tool (DASH, LEFS, Spinal Functional Index (not published yet)) to capture change. The OPTIMAL is a more general type of tool and whenever a more general type of tool is used the tool generally doesn't capture change as well.
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RE: PTA's as "Therapists" - December 10, 2007 10:17:00 PM
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KAK
Posts: 200
Joined: December 1, 2004
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quote:
So where does all this fall? Training. If you are good at what you do, it doesn't matter a heck of a lot what you have as credentials behind our names.
I understand what you are saying. However, I think it matters legally and ethically.
Think about what Reenie said, quote:
“I also explain to them that the only thing that I cannot do that a PT does is evaluate. And in my clinic that is the way it is!”
Who is doing the manual treatments? Who is modifying the plan of care? Why is she doing re-evals and discharges?
In my state, the law states:
(D) The physical therapist shall personally perform the following activities, which may not be delegated, regardless of the setting in which the service is given:
(1) Interpretation of physician referrals;
(2) Initial patient evaluation;
(3) Initial and ongoing treatment plan of care development;
(4) Periodic re-evaluation of the patient and adjustment of the plan of care; and
(5) Discharge evaluations
Obviously, for quality care to occur, on going plan development is necessary. If a PT is not keeping close enough tabs on a patient, and this is falling to a PTA, it’s wrong. Now, as to Reenie dictating re-evals and having “done discharges”; this just plain illegal in my state. I can’t speak to FL law, though I imagine it’s similar.
Here is the ethical issue:
Maybe PTA’s, though not legally therapists, feel as though they are therapists, because they are being allowed to function as such. I don’t blame them, but the PT’s who are willing to sell our profession short so that someone can make a buck. I believe, as the APTA points out, that it is the therapist’s sole responsibility for:
“Determination of when the expertise and decision-making capability of the physical therapist requires the physical therapist to personally render physical therapy interventions and when it may be appropriate to utilize the physical therapist assistant. A physical therapist shall determine the most appropriate utilization of the physical therapist assistant that provides for the delivery of service that is safe, effective, and efficient.”
I have seen the trend, where the PT evaluates the patient, then never sees them again, indiscriminately delegating the whole kit and caboodle. I take great ethical issue with this.
Finally, this is the APTA’s definition of a PTA:
“The physical therapist assistant is a technically educated health care provider who assists the physical therapist in the provision of physical therapy. The physical therapist assistant is a graduate of a physical therapist assistant associate degree program accredited by the Commission on Accreditation in Physical Therapy Education (CAPTE).”
quote:
I think the PT's of this board are missing the point!
Reenie, I can only speak for myself here. If your point was that PTA’s can be effective, capable, intelligent, creative and competent care givers, I agree. However,if your point is that PTA’s are “mini-therapists”, I didn’t miss that either, but completely disagree.
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RE: PTA's as "Therapists" - December 10, 2007 10:49:21 PM
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reeniePTA
Posts: 17
Joined: October 21, 2005
From: Rochester, NY
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KAK, obviously you are not up to speed on all the laws in every state. But here in Florida, PTAs CAN & DO manual therapy treatments. And by the way, I AM DOING THE MANUAL THERAPY TREATMENTS on my patients!! Yep, that's right, my PTs have actually trained me in the different manual therapies that they use. And you know, I can even treat without a PT being in the building in the OP Ortho setting. Imagine that!!!
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RE: PTA's as "Therapists" - December 10, 2007 11:44:45 PM
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PamPT
Posts: 20
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From: Maryland
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WOW! I personally have had little need to work with PTA's in my career. Early on I have seen other therapist with PTA's perform unethical practices as it relates to my state law (PT's doing initial eval's and doing nothing else) because the PTA is so "great" there was no need for supervision and keeping tabs on patients evaluated. This practice is illegal. Personally I do not care how good PTA's are, the law is the law and as PT's we have an obligation to our patients and profession to follow the law. I do not know the law in FL, but it is very different in Maryland. I feel there are so many issues being brought up in this tread. The main issue is the definition of a physical therapist assistant. The other issues are how we as PT's value PTA's, ethical/legal practices, industry needs for PTA in various settings. Personally, in my practice/setting I do all of my own evaluations, treatments, discharges, manual therapy and so on. I see patients in inpatient acute care, home care and outpatient (lymphedema) these patients tend to be unstable, and/or require constant critical thinking and adjustments with all treatments. It is not effecient in my setting to delegate responsiblities to a physical therapist assistant.
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RE: PTA's as "Therapists" - December 10, 2007 11:55:30 PM
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jlharris
Posts: 469
Joined: April 12, 2006
From: Nebraska
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That's too bad Florida is devaluing PT in that way. I've said it before, and I'll say it again. If you want to be a captain, go to captain school. Or to make it more clear, if you want to be a physical THERAPIST go to PT school and not PTA school and hope to slide in the back door because the PT lets you.
I say the same thing about PA's swearing they went to mini Med school, and try to act like they are physicians. Again, if you want to be the captain sacrifice and do it the right way. Don't find ways to manipulate the system, get a 2 year degree and then pretend you are something you are not.
As you can tell, I have not, and plan on never "utilizing" a PTA. Fine for the hospital where the pt's need walked or in aquatics where you can do group therapy, bill individual, and get even better return b/c it's was provided by a less qualified PTA paid a third to a half less than the PT.
Here are the rules and regs for PTA's in my state:
Physical therapist assistant; perform physical therapy services; when; limitations; supervising physical therapist; powers and duties. (1) A physical therapist assistant may perform physical therapy services under the general supervision of a physical therapist, except that no physical therapist assistant shall perform the following:
(a) Interpretation of physician referrals;
(b) Development of a plan of care;
(c) Initial evaluations or reevaluation of patients;
(d) Readjustment of a plan of care without consultation with the supervising physical therapist; or
(e) Discharge planning for patients.
(2) A physical therapist may provide general supervision for no more than two physical therapist assistants. A physical therapist shall not establish a satellite office at which a physical therapist assistant provides care without the general supervision of the physical therapist.
(3) A physical therapist shall reevaluate or reexamine on a regular basis each patient receiving physical therapy services from a physical therapist assistant under the general supervision of the physical therapist.
(4) A supervising physical therapist and the physical therapist assistant under general supervision shall review the plan of care on a regular basis for each patient receiving physical therapy services from the physical therapist assistant.
(5) A physical therapist assistant may document physical therapy services provided by the physical therapist assistant without the signature of the supervising physical therapist.
(6) A physical therapist assistant may act as a clinical instructor for physical therapist assistant students in an approved educational program.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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RE: PTA's as "Therapists" - December 11, 2007 7:30:02 AM
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SJBird55
Posts: 2357
Joined: May 10, 2004
From: Michigan
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Ummm, ReeniePTA... you've got issues. Your state practice act may allow for PTA's to supposedly function without a PT in the building for outpatient PT (and your employer may also) BUT... guess what? Medicare rules and regulations do NOT allow for a patient to be treated without a PT in the building for part B services. So, any time that PTAs are the providers solely providing services without a PT in the building, according to Medicare you are committing fraud. If you come back and state that you don't treat Medicare patients without a PT in the building, now you have yourself cornered into an ethical dilemma as to why there is a difference in provision of services based on payor.
I practice as Jason and KAK... I have no need for a PTA and have no plans of hiring a PTA in my clinic. ReeniePTA, I suggest you look into more than just your state practice act and also know the rules and regulations for your payors. There are some BCBS policies that specifically state that physical therapy services can only be provided by a PT. The little issue of whether you are a "therapy assistant" or a "therapist assistant" is such a minor thing compared to some other aspects of your position you have disclosed. My interpretation of some of your comments is that unknowingly you may be committing fraud.
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RE: PTA's as "Therapists" - December 11, 2007 1:50:25 PM
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reeniePTA
Posts: 17
Joined: October 21, 2005
From: Rochester, NY
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Umm, SJBird55, I don't treat Medicare pts. Believe me, my clinic would not let anything illegal happen. And I beg your pardon for suggesting that my clinc would allow anything illegal to occur w/o knowing ALL the facts!!!!
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RE: PTA's as "Therapists" - December 11, 2007 6:20:28 PM
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KAK
Posts: 200
Joined: December 1, 2004
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Reenie,
Of course I am not up on FL law, but by googling I found this from your law:
64B17-6.001 Minimum Standards of Physical Therapy Practice.
(c) The physical therapist shall not delegate any function or task which requires the skill, knowledge, and judgment of the physical therapist.
(4) The Physical Therapist Assistant Responsibilities.
(a) The physical therapist assistant shall not initiate or change treatment without the prior assessment and approval of the physical therapist.
quote:
I also explain to them that the only thing that I cannot do that a PT does is evaluate.
I don’t want to take my time to beat a dead horse (sorry for the metaphor SJ), but to say: Reenie, you can’t legally change the treatment on your own. This is only one difference you may consider before continuing to tell patients the above.
SJ,
I do have a PTA that I will now be working with. I think she is going to work out well and understands that I will discriminately delegate to her as I get a feel for her skill level and each patient’s appropriateness.
quote:
Medicare rules and regulations do NOT allow for a patient to be treated without a PT in the building for part B services.
Do you have this reference handy? I work in a hospital based satellite clinic and PTA’s will on occasion be assigned by my supervisor to cover for me when off. It is legal, and I thought with hospital based OP clinics it was OK with Medicare.
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RE: PTA's as "Therapists" - December 12, 2007 12:00:43 AM
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SJBird55
Posts: 2357
Joined: May 10, 2004
From: Michigan
Status: offline
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KAK... I errored. (I'm always so focused on private practice.) A PTA can't cover for a PT. Another PT is required to supervise a PTA in the hospital setting, but in the hospital setting the supervising PT does not have to be on the premise - just has to be available. At the bare minimum, in a hospital setting a PT has to be onsite every 30 days or more to meet Medicare requirements. In the private practice setting (which is where I misspoke making too general of a statement only stating Part B), the PTA has to be supervised by a PT that is physically in the office suite. I apologize for my misinformation.
2007 transmittals for chapter 15 of the Medicare benefit policy make this more clear than myself. And... Transmittal 60 dated November 9, 2006 Change request 5271 vaguely addresses supervision. Both give definite information as to the PTA role.
Ummm, ReeniePTA, fraud happens at all levels. The description of your role and the role as it should be are conflicting.
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