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?
Joined: May 11, 2004
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?
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.
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.
Joined: February 14, 2003
From: Madison WI USA
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.
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?
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.
Joined: January 25, 2003
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.
Dr. Wagner DO Moderator of Medical Complexity Forum
Joined: March 23, 2006
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...
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.