Re: Utilization of aides and students in SNF

[Guest guest]

MS. Wheeler:

I agree that the appropriate route here is to attempt to change the ruling. If

we as a profession feel that the time we are

being given to treat patients is inadequate, we must fight to change the ruling

- not fill the gaps with unreimbursed time.

Although this gap filling APPEARS to meet the needs of the patient, it does so

only on a piece meal basis. If additional

time is what we need, then let's work to change the decision.

G. Flickinger, PT

Emmy Wheeler wrote:

> ,

> This is an interesting discussion on allowing students to affiliate in SNFs.

Guess we will hear more about this later.

> Emmy

>

> Re: Utilization of aides and students in SNF

>

> I believe there are a few problems with the proposal that students be

> utilized to provide the " extra " minutes in PPS that we think the patient

> needs, but that are not reimbursed under the current system. I'll start

> out with just a couple:

>

> First, it establishes two different levels of care for a patient -- one

> level when and if there are students around, and another level when there

> are no students. [unless, of course, the therapists were planning to

> provide those extra minutes at no charge when there are no students around]

>

> Another issue is that although I think it's great for patients to get

> optimal care, we have to decide what the costs are to our professions if we

> simply continue to take devastating hits from payers without any

> consequence to anyone but ourselves. The public has to decide if the level

> of care we can offer based on the new reimbursement is acceptable to them.

> If we supplement the care with free care [either on our own or through the

> use of students], then what will be the motivation for payers to reverse

> course and reimburse more appropriately? The public will still be getting

> excellent care and the payers win because they pay us less. As hard as it

> is for all of us to see patients get less than we think they need and

> deserve, we help no one in the long run if we just keep absorbing cuts. At

> some point we will not survive financially and then no one will get the

> benefit of our expertise.

>

> Instead, I would propose that this is a time for the professional

> associations, the academic accrediting bodies, and individual therapists

> and professional students to join forces and have this ruling changed. It

> clearly makes no sense since students are educated and supervised, and

> seems to be a decision made by HCFA without adequate input from experts.

> Other such decisions have been changed -- perhaps this one can be also.

>

> At 07:46 PM 8/1/99 -0400, you wrote:

> > Bartkiewicz wrote:

> >>

> >>

> >> Group,

> >>

> >> We have finally received the information concerning the use of aides

> >> in the SNF(pg.. 41661 Fed Reg). My concern is the ruling on the use

> >> of students. The rules and regulations indicate that a student and an

> >> aide may provide therapy services within " line-of-sight " supervision,

> >> but the time spent by a student can not be recorded on the MDS.

> >>

> >> How did HCFA determine it is appropriate to account for time an aide

> >> spent with a patient, but not time a student spent with a patient?

> >> What does this mean to our profession? It will be very hard, actually

> >> impossible for me to justify to my administrator why I am taking

> >> students. (For the benefit of the PT profession will not cut it.)

> >

> >I don't entirely agree that this need be so. Right now, facilities are

> >(at the moment) limiting the amount of time PTs can spend with patients

> >so that it matches the minimum defined for that RUG level. Many

> >clinicians do not feel their patients are receiving adequate PT. Why

> >could not students supply some of this therapy, freeing clinicians to

> >see another patient? For example, let's say you are only " allowed " 420

> >minutes per week with a patient, but you estimate the person needs 840

> >minutes. Working with a student as a two-person team, you could ensure

> >you don't spend more than 420 minutes (causing your facility to lose

> >money), the student spends the rest of the time, and the patient can

> >still receive adequate PT care. From a purely business perspective, and

> >assuming that there are adequate patient numbers, more patients can be

> >seen by one PT, yet the patients receive more " PT " . Patients benefit,

> >because they receive more care than they would receive from clinicians

> >alone under the way the system is curently working.

> >

> >This would require some re-thinking of the typical student role in the

> >clinical setting at later stages, i.e. they would not handle their own

> >caseload entirely independently. In other words, the student's and

> >clinician's caseloads would comprise largely the same patients.

> >

> >Sandy Curwin

> >Bangor, Maine

> >

> >

> >

> >>

> >> It will be very difficult to get PT students exposure in the SNF. I

> >> would appreciate comments on how we can address this issue.

> >>

> >>

> >>

> >> Bartkiewicz, PT

> >>

> >>

> >>

> >>

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> >

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> >

>

> ***********************************************

> Janice Kuperstein, PT, MSEd

> Assistant Professor

> University of Kentucky College of Allied Health Professions

> 121 Washington Avenue

> Lexington, KY 40536-0003

> Telephone: 606 - 323-1100 ext 261

> Fax: 606 - 257-1816

>

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