O.T in modalities? (Full Version)

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Mr. PT -> O.T in modalities? (August 29, 2006 1:03:00 AM)

I'm currently working in a skilled nursing facility here in Texas and lately, the corporate bosses have demanded PT / OT to utilize the modalities ( SWD, US and ES ) towards our patients. We received 5 hours of training from ACP ( who leases the modalities with the company ) with a short hands-on demonstrations on mostly pre-set parameters.

My question is, how sufficient is it for OTR's and COTA's to learn about these modalities in 5 hours and then apply it to our patients?

Without Electrotherapy background I don't know how this affects the OTR's judgment regarding the use of these modalities.

I was also wondering when our modalities became a part of Occupational Therapy since it is not in their course curriculum?




SJBird55 -> Re: O.T in modalities? (August 29, 2006 6:55:00 AM)

Why would corporate bosses be demanding modalities be utilized? Do the patients really need those modalities? What are the modalities to achieve? In what type of patient condition/diagnosis will those modalities be utilized? Is there evidence demonstrating that for the specific condition and patient good outcomes will be achieved?

Whenever someone in an administrative role "demands" something be utilized on patients, a little red flag goes up in my brain. From what you wrote, the bigger question isn't WHO is performing the modality, but WHY? AND, is the utilization of modalities appropriate?




Sebastian Asselbergs -> Re: O.T in modalities? (August 29, 2006 7:02:00 AM)

I am not in the States, but I find it very ODD that a "boss" (PT or not?) can dictate the actual provision of physical therapy modalities by practitioners (be it OT or PT). It sounds like a business deal was made without any clinical input as to the appropriateness of the leasing of the equipment. On top of that, "pooling" OT and PT to deliver modalities is at best a very dubious ethical issue.

The question about who can do what, is really moot - you have just stated that, even as a MSPT, you have NO electrotherapy "background". This does not seem that much different from OTs NOT having modalities-oriented backgrounds....
Which in itself is not such a bad thing after all, now that I think about it....Modalities are overrated anyway LOL.




TMondale -> Re: O.T in modalities? (August 29, 2006 7:34:00 AM)

Cyril,

On how many levels does this scenario you describe stink? First of all I agree with sebastian in terms of who is qualified to apply the modality. the bigger smelly fish is that your employers feel it is within their right to influence your and your colleagues clinical judgement. The answer is money, now what's the question. It goes on all the time and it has to be up to a strong professional response that says we are going to make clinical decissions based on the what's good for the patient, and not abusive to the third party payor. Further, patients that no longer are candidates to benefit from skilled PT services should be set up with house maintenance programs and discharged from PT (personal diatribe). You are letting the profession down if you don't recognize this for what it is and stand firm.

I have lost jobs in the past for this very reason. It's worth it no matter how much they may pay.

Tim




proud -> Re: O.T in modalities? (August 29, 2006 7:35:00 AM)

Yes, the question is not who...but why? Big Big flags.

Any boss or owner that "demands" utilizing something, I would question my future employment there.




Shill -> Re: O.T in modalities? (August 29, 2006 8:10:00 AM)

Your corporate bo$$e$ are encouraging unethical practice to drive up their bottom line. Note that they are not recommending, just encouraging. Either way it$ bad, but encouraging is probably not illegal, just unethical and immoral. That i$ likely how they justify it. Hmmm.... wait a minute here.....It $eem$ that my "$" key i$ a bit dy$functional. Maybe it need$ $ome E-$tim, or Ultra$ound.




Mr. PT -> Re: O.T in modalities? (August 29, 2006 9:05:00 AM)

I understand all your points that the bottom line in all these is to maximize the utilization of the modalities to generate more income particularly in the Medicare Part B patients.

But my real question is, how qualified are OT's / COTA's in delivering and applying these modalities ( Short Wave Diathermy, US and ES ) safely to the residents given the fact that they only received 5 hours of training?

Is it enough time for OT / COTA's to know how these modalities work compared to the 2 semesters of Electrotherapy PT's have to study in our curriculum?




Sebastian Asselbergs -> Re: O.T in modalities? (August 29, 2006 9:35:00 AM)

The difficulty is not how to operate safely - that's very easily done and 5 hours training is sufficient IMO.
The issues that needs much more education are: who to apply it to, for what condition(s), and with what contra-indications, supported by what research, and aimed at what patient outcome.
That's where danger of error and malpractice lurks.

So IOW, I understand your question and concern, but I think it is really moot for a PT to be concerned with what other professionals do or don't do. Unless they are doing it while you are supervising PT, it is THEIR neck in a noose if things go wrong.

I really really suggest you look VERY hard at where you work and looking for other employ or practice setting. Honestly. The fact that such an issue even exists in a workplace, does not bode well for their ethical standards.

Good luck!




yarringtonpt -> Re: O.T in modalities? (August 29, 2006 12:18:00 PM)

Cyril:

I have worked with OT's and COTA's in the passed and they were trained in the use of modalities as I was in PT school. Is this not the case for those with whom you work?

But, I agree that you have bigger concerns as others have stated.

Eric




Dr.Wagner -> Re: O.T in modalities? (August 29, 2006 1:40:00 PM)

Yeah, OTs and COTAs are trained to use modalities (for that matter so are ATC's etc)...but that scenerio you painted screams of unethical practice patterns.
To be honest, based upon my early experience with a certain group in the midwest (as a PT), ECF billing is...uh...padded.
Perhaps I missed this somewhere in your response, but did you state that the move towards modalities was based on the "referals" (ie wound care)or on company policy.




ptjosh -> Re: O.T in modalities? (August 29, 2006 2:18:00 PM)

Our modalities? ha they can have them...for all but a small number of situations they are essentially useless...




Mr. PT -> Re: O.T in modalities? (August 29, 2006 2:26:00 PM)

This really concerns me because as far as I can remember ( being a PT for 15 years ) we are the only healthcare professional that are " LICENSED " by the State Board to use these modalities!

Modalities are a part of our " license " because if during the State Board Exams you failed in Electrotherapy, you will surely fail the board exams too and therefor not licensed to work as a PT!

It would be different story if Electrotherapy is also included in the OT/COTA State Board Exams.

What has been an exclusive PT treatment modality has now become toys for others!

What else is next?




proud -> Re: O.T in modalities? (August 29, 2006 2:50:00 PM)

Cyril,

Likely they are becoming toys for others because we are once again ahead of the pack in regards to emerging research. They can have them. As long as we are the ones who know the research about what conditions can be treated with what modalities, then who cares? They can go ahead and ultrasound that low back all they want...




Sebastian Asselbergs -> Re: O.T in modalities? (August 29, 2006 4:18:00 PM)

BTW, modalities have NOT been exclusive to PT: ask any chiropractor. Some of them have been using "physical therapy modalities" for just as long as we have. And completely within most of their states' standards, if I'm not mistaken.




Mr. PT -> Re: O.T in modalities? (August 29, 2006 4:24:00 PM)

But they ( chiro's, MD's ) cannot bill them as a PT procedure without a licensed PT in their clinic.

In the State Of Texas, they have to register their facility to the PT State Board in order to perform PT treatments with a supervising PT signing out the application / registration.




nari -> Re: O.T in modalities? (August 29, 2006 4:26:00 PM)

Proud,

Well spoken. They can have them; we don't own them, some like them , others don't bother.

Does it really matter?


Nari




Mr. PT -> Re: O.T in modalities? (August 29, 2006 4:45:00 PM)

Then they need to remove Electrotherapy in our curriculum and State Board Exams then!

Why give our PT students the hard time studying the subject when others think they can learn the subject in 5 hours!




Mr. PT -> Re: O.T in modalities? (August 29, 2006 4:56:00 PM)

And I've known some friends who failed to make it in the State Board Exams because of Electrotherapy!




ptjosh -> Re: O.T in modalities? (August 29, 2006 5:39:00 PM)

lol your funny




Sebastian Asselbergs -> Re: O.T in modalities? (August 29, 2006 5:47:00 PM)

Cyril, you said: "What has been an exclusive PT treatment modality has now become toys for others!"

You never mentioned "billing" - you were talking about modalities being exclusively PT.

And I agree with you about removing them from curriculi - it IS a waste of time.




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