RE: Re: So we can use techs or aides to perform part of our treatment? (Not medicare)

May 2, 2008

I agree. But that's the problem, there should not be

such left up to interpretation. They do exactly what

you mention. They state skilled PT interventions can

be learned on the job (if the therapist thinks it is

adequate). Our laws and rules in each state should

specifically state " an aide cannot be utilized to

perform a-b-c.. " My Florida practice act specifies

what aides cannot do, but treatment is not one of

them. The duties that are specifically excluded for

aides do not mention treatment. So basically an aide

can perform any duties that a PTA can if trained on

the job. Unfortunately there are many therapists who

will use an aide beyond modality setup. If we use

aides for therapeutic exercise or manual therapy, we

are no different than a chiropractor using a

chiropractic assistant to provide billable services,

or an MD wanting to use a medical assistant or

athletic trainer. Our act needs to be amended.

Bisesi MPT COMT

Winter Haven, Fl

--- Ron Barbato wrote:

> My concern with this thread is the terminology -

> delegated duties, with

> established competency "

> Are we saying that skilled PT interventions can be

> " learned on the job "

> Fellow colleagues, that is a very slippery slope

> with significant

> implications

> Use of non licensed aides to perform skilled

> billable physical therapy

> service is unacceptable.

>

> Ron Barbato PT

> Administrative Director, Rehabilitation Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@...

> Member, KY Board of Physical Therapy

>

> PRIVILEGED AND CONFIDENTIAL: This transmission may

> contain information

> that is privileged subject to attorney-client

> privilege or attorney work

> product, confidential and/or exempt from disclosure

> under applicable

> law. If you are not the intended recipient, then

> please do not read it

> and be aware that any disclosure, copying,

> distribution, or use of the

> information contained herein (including any reliance

> thereon) is

> STRICTLY PROHIBITED. If you received this

> transmission in error, please

> immediately advise me, by reply e-mail, and delete

> this message and any

> attachments without retaining a copy in any form.

> Thank you.

>

> Re: So we can use techs or

> aides to perform part of

> our treatment? (Not medicare)

>

> - Ssate practice acts governing the rules and

> laws of PT

> differ greatly in that respect. However, over the

> last two decades,

> states have generally become more restrictive on

> delegation issues,

> following the lead of the APTA, which supports only

> the PT and the

> PTA are the only providers of physical therapy

> services. Here is a

> link from the Federation showing a state by state

> guide of this:

> http://www.fsbpt.org/RegulatoryTools/ReferenceGuide/

>

> Don Walsh, PT, MS, OCS

> Gainesville GA

>

> >

> > Why does the Florida practice act appear to allow

> us

> > to delegate portions of treatment to aides and

> bill

> > for it? This is the " excemptions " section, please

> not

> > excemption (3). If an employer references this and

> > argues that an athletic trainer, or even a PT aide

> can

> > be trained by a PT to assist in the clinic for

> > non-medicare patients, how does a PT manager or PT

> > counter this point?

> >

> > 486.161 Exemptions.--

> >

> > (1) No provision of this chapter shall be

> construed

> > to prohibit any person licensed in this state from

> > using any physical agent as a part of, or

> incidental

> > to, the lawful practice of her or his profession

> under

> > the statutes applicable to the profession of

> > chiropractic physician, podiatric physician,

> doctor of

> > medicine, massage therapist, nurse, osteopathic

> > physician or surgeon, occupational therapist, or

> > naturopath.

> >

> > (2) No provision of this chapter shall be

> construed

> > to prohibit:

> >

> > (a) Any student who is enrolled in a school or

> course

> > of physical therapy approved by the board from

> > performing such acts of physical therapy as are

> > incidental to her or his course of study; or

> >

> > ( Any physical therapist from another state

> from

> > performing physical therapy incidental to a course

> of

> > study when taking or giving a postgraduate course

> or

> > other course of study in this state, provided such

> > physical therapist is licensed in another

> jurisdiction

> > or holds an appointment on the faculty of a school

> > approved for training physical therapists or

> physical

> > therapist assistants.

> >

> > (3) No provision of this chapter prohibits a

> licensed

> > physical therapist from delegating, to a person

> > qualified by training, experience, or education,

> > specific patient care activities, as defined and

> > limited by board rule, to assist the licensed

> physical

> > therapist in performing duties in compliance with

> the

> > standards of the practice of physical therapy.

> > Specific patient care activities, as defined and

> > limited by board rule, must be performed under the

> > direct supervision of the licensed physical

> therapist

> > or physical therapist assistant in the immediate

> area,

> > if the person is not a licensed physical therapist

> > assistant.

> >

>

_____________________________________________________________________

> _______________

> > Be a better friend, newshound, and

> > know-it-all with Yahoo! Mobile. Try it now.

>

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

> >

>

> ------------------------------------

>

> In ALL messages to PTManager you must identify

> yourself, your discipline

> and your location or else your message will not be

> approved to send to

> the full group.

>

> PTManager encourages participation in your

> professional association.

> Join APTA, AOTA or ASHA and participate now!

>

> Visit the NEW and IMPROVED www.InHomeRehab.com.

>

May 2, 2008

Hi Rob,

Please remember that CMS (Medicare) does not mandate that anyone has to see

one patient at a time. They do require truth in billing such that if you

are billing one-on-one codes, you better be treating one-on-one. And they

require the proper use of group billing codes when more than one Medicare

client is being seen at a time.

Whether we want to admit it or not, Medicare has simply responded to the

gross overutilization of one-on-one CPT codes by unscrupulous practices who

bilked Medicare for millions in fraud. And they responded to the gross

overutilization of aides to do " treatment " as well by mandating restrictions

on their use.

While I'm no fan of insurances and their rules, remember also that our

professional organization has agreed upon very restrictive policies on aide

use and utilization, policies based on hours and hours of testimony and

debate. These policies were not taken lightly but were based on what is in

the best interest of the public that we serve.

As I have stated before, it is my opinion that utilizing aides to do

treatment devalues our profession. Patients come to you clinic wanting to

see you, the PT, not your aide, not you and six other patients. Utilizing

aides is allowed in a lot of state practice acts, for sure, but it still is

a choice that a clinic owner can make. Insurances are demanding that PT's

honor the contracts that are signed to serve their beneficiaries in which it

is understood that their beneficiaries are being seen by a PT, not an aide.

I fail to see how delegating treatment to aides improves treatment. All I

see is that it is a way to see more patients in a day and make more money.

And as has been illustrated on this list, there are plenty of practitioners,

who follow the rules, that are doing just fine in the profit column AND are

not utilizing aides for treatment.

It is up to you to make the choice

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

howellpt@...

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Jordan

Sent: Friday, May 02, 2008 9:16 AM

To: PTManager

Subject: RE: Re: So we can use techs or aides to perform part of

our treatment? (Not medicare)

It's feather ruffling time...You know guys, I completely agree with the

comments made on this posting with regards to delegation of skilled

interventions to aides. This debate crops up frequently in many different

circles and the result is always the same. I have one consideration on this

topic and I would like to request that we all just step back, take a breath,

and consider what is at stake. Most of you would agree that we are being

regulated to death by CMS and other government beaurocracies. Insurance

companies do not value what we do. Every day, we are told what to do, how

to do it, how long to do it and then after we do it, we are told that what

we did was not medically necessary. Many in our profession will adamantly

state that it is " unethical " to treat more than one patient at a time.

What? When did that get carved in stone? Since when is the senseless

mandate of a government regulatory agency (Medicare) the yardstick of

ethical practice? We have become so suppressed by Medicare, insurance

companies and physicians that we actually believe what we are incapable of

sound professional judgment. Our profession is de-volving in its ability to

determine its own destiny. Debates like this simply give credibility to

outside agencies bent on exerting ever-increasing control over us. As a

licensed professional each therapist should have the wherewithal and the

judgment to determine what is best for their patients and should have the

authority to delegate some of those responsibilities. Should techs be doing

manipulation or joint mobilization? Of course not! Could a tech be trained

to administer ultrasound, iontophoresis or apply electrodes? Of course they

could. Could a tech count repetitions of SLRs, QS, or shoulder pulleys?

I'm thinking, yes. I understand that " if you give some people and inch,

they will take a mile. " That is human nature. Is it right? NO. Should we

all put shackles on ourselves to prevent the bad ones from taking over the

world? I think not. Guys, all I am saying is let's not add more

burdensome regulations to an already over-regulated industry. If the guys

down the street are doing a bad job by using techs improperly, then dedicate

your efforts to doing a better job. The best revenge is to flourish and

prosper. Some advice from an old-timer.

Rob Jordan, PT, MPT, GCS, OCS

_____

From: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

[mailto:PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com] On

Behalf

Of Ron Barbato

Sent: Friday, May 02, 2008 9:03 AM

To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

Subject: RE: Re: So we can use techs or aides to perform part of

our treatment? (Not medicare)

My concern with this thread is the terminology - delegated duties, with

established competency "

Are we saying that skilled PT interventions can be " learned on the job "

Fellow colleagues, that is a very slippery slope with significant

implications

Use of non licensed aides to perform skilled billable physical therapy

service is unacceptable.

Ron Barbato PT

Administrative Director, Rehabilitation Services

Ephraim McDowell Health

Voice:

Fax:

HYPERLINK " mailto:rbarbato%40emrmc.org " rbarbatoemrmc (DOT) -org

Member, KY Board of Physical Therapy

PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

that is privileged subject to attorney-client privilege or attorney work

product, confidential and/or exempt from disclosure under applicable

law. If you are not the intended recipient, then please do not read it

and be aware that any disclosure, copying, distribution, or use of the

information contained herein (including any reliance thereon) is

STRICTLY PROHIBITED. If you received this transmission in error, please

immediately advise me, by reply e-mail, and delete this message and any

attachments without retaining a copy in any form. Thank you.

Re: So we can use techs or aides to perform part of

our treatment? (Not medicare)

- Ssate practice acts governing the rules and laws of PT

differ greatly in that respect. However, over the last two decades,

states have generally become more restrictive on delegation issues,

following the lead of the APTA, which supports only the PT and the

PTA are the only providers of physical therapy services. Here is a

link from the Federation showing a state by state guide of this:

HYPERLINK

" http://www.fsbpt. <http://www.fsbpt.org/RegulatoryTools/ReferenceGuide/>

org/RegulatoryTools/ReferenceGuide/ " http://www.fsbpt.

<http://www.fsbpt.-org/> -org/

RegulatoryTo-ols/ReferenceGui-de/

Don Walsh, PT, MS, OCS

Gainesville GA

>

> Why does the Florida practice act appear to allow us

> to delegate portions of treatment to aides and bill

> for it? This is the " excemptions " section, please not

> excemption (3). If an employer references this and

> argues that an athletic trainer, or even a PT aide can

> be trained by a PT to assist in the clinic for

> non-medicare patients, how does a PT manager or PT

> counter this point?

>

> 486.161 Exemptions.---

>

> (1) No provision of this chapter shall be construed

> to prohibit any person licensed in this state from

> using any physical agent as a part of, or incidental

> to, the lawful practice of her or his profession under

> the statutes applicable to the profession of

> chiropractic physician, podiatric physician, doctor of

> medicine, massage therapist, nurse, osteopathic

> physician or surgeon, occupational therapist, or

> naturopath.

>

> (2) No provision of this chapter shall be construed

> to prohibit:

>

> (a) Any student who is enrolled in a school or course

> of physical therapy approved by the board from

> performing such acts of physical therapy as are

> incidental to her or his course of study; or

>

> ( Any physical therapist from another state from

> performing physical therapy incidental to a course of

> study when taking or giving a postgraduate course or

> other course of study in this state, provided such

> physical therapist is licensed in another jurisdiction

> or holds an appointment on the faculty of a school

> approved for training physical therapists or physical

> therapist assistants.

>

> (3) No provision of this chapter prohibits a licensed

> physical therapist from delegating, to a person

> qualified by training, experience, or education,

> specific patient care activities, as defined and

> limited by board rule, to assist the licensed physical

> therapist in performing duties in compliance with the

> standards of the practice of physical therapy.

> Specific patient care activities, as defined and

> limited by board rule, must be performed under the

> direct supervision of the licensed physical therapist

> or physical therapist assistant in the immediate area,

> if the person is not a licensed physical therapist

> assistant.

>

____________-_________-_________-_________-_________-_________-_

____________-___

> Be a better friend, newshound, and

> know-it-all with Yahoo! Mobile. Try it now.

HYPERLINK

" http://mobile. <http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ>

yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ " http://mobile.

<http://mobile.-y> -y

ahoo.com/-;_ylt=Ahu06i62sR-8HDtDypao8Wcj9tA-cJ

>

---------------------------------------

In ALL messages to PTManager you must identify yourself, your discipline

and your location or else your message will not be approved to send to

the full group.

PTManager encourages participation in your professional association.

Join APTA, AOTA or ASHA and participate now!

Visit the NEW and IMPROVED www.InHomeRehab.-com.

May 2, 2008

Tom,

I completely understand your statements. I think, however, you

misunderstood mine. I followed the rules for 18 years of practice.

There is no " choice " to make. If you seriously believe that you can

follow Medicare rules and " still do OK in the profit department " I

think I would have to respectfully disagree. My point was that we keep

tightening the reigns on ourselves by quoting high and mighty ethics.

I just think it is sad that we have lost the ability to think for

ourselves. Thank God we have Medicare to tell us what is ethical and

what is not. You are correct in stating that we have to choose.

Unfortunately, we have given up all rights to choose. As a result, we

spend 8-22 minutes counting straight leg raises. Do we need DPTs to do

that?

Rob Jordan, PT, MPT, GCS, OCS

Sent from iPhone

On May 2, 2008, at 1:41 PM, " thomas m howell "

wrote:

> Hi Rob,

>

> Please remember that CMS (Medicare) does not mandate that anyone has

> to see

> one patient at a time. They do require truth in billing such that if

> you

> are billing one-on-one codes, you better be treating one-on-one. And

> they

> require the proper use of group billing codes when more than one

> Medicare

> client is being seen at a time.

>

> Whether we want to admit it or not, Medicare has simply responded to

> the

> gross overutilization of one-on-one CPT codes by unscrupulous

> practices who

> bilked Medicare for millions in fraud. And they responded to the gross

> overutilization of aides to do " treatment " as well by mandating

> restrictions

> on their use.

>

> While I'm no fan of insurances and their rules, remember also that our

> professional organization has agreed upon very restrictive policies

> on aide

> use and utilization, policies based on hours and hours of testimony

> and

> debate. These policies were not taken lightly but were based on what

> is in

> the best interest of the public that we serve.

>

> As I have stated before, it is my opinion that utilizing aides to do

> treatment devalues our profession. Patients come to you clinic

> wanting to

> see you, the PT, not your aide, not you and six other patients.

> Utilizing

> aides is allowed in a lot of state practice acts, for sure, but it

> still is

> a choice that a clinic owner can make. Insurances are demanding that

> PT's

> honor the contracts that are signed to serve their beneficiaries in

> which it

> is understood that their beneficiaries are being seen by a PT, not

> an aide.

>

> I fail to see how delegating treatment to aides improves treatment.

> All I

> see is that it is a way to see more patients in a day and make more

> money.

> And as has been illustrated on this list, there are plenty of

> practitioners,

> who follow the rules, that are doing just fine in the profit column

> AND are

> not utilizing aides for treatment.

>

> It is up to you to make the choice

>

> Tom Howell, P.T., M.P.T.

>

> Howell Physical Therapy

>

> Eagle, ID

>

> howellpt@...

>

> _____

>

> From: PTManager [mailto:PTManager ]

> On Behalf

> Of Jordan

> Sent: Friday, May 02, 2008 9:16 AM

> To: PTManager

> Subject: RE: Re: So we can use techs or aides to perform

> part of

> our treatment? (Not medicare)

>

> It's feather ruffling time...You know guys, I completely agree with

> the

> comments made on this posting with regards to delegation of skilled

> interventions to aides. This debate crops up frequently in many

> different

> circles and the result is always the same. I have one consideration

> on this

> topic and I would like to request that we all just step back, take a

> breath,

> and consider what is at stake. Most of you would agree that we are

> being

> regulated to death by CMS and other government beaurocracies.

> Insurance

> companies do not value what we do. Every day, we are told what to

> do, how

> to do it, how long to do it and then after we do it, we are told

> that what

> we did was not medically necessary. Many in our profession will

> adamantly

> state that it is " unethical " to treat more than one patient at a time.

> What? When did that get carved in stone? Since when is the senseless

> mandate of a government regulatory agency (Medicare) the yardstick of

> ethical practice? We have become so suppressed by Medicare, insurance

> companies and physicians that we actually believe what we are

> incapable of

> sound professional judgment. Our profession is de-volving in its

> ability to

> determine its own destiny. Debates like this simply give credibility

> to

> outside agencies bent on exerting ever-increasing control over us.

> As a

> licensed professional each therapist should have the wherewithal and

> the

> judgment to determine what is best for their patients and should

> have the

> authority to delegate some of those responsibilities. Should techs

> be doing

> manipulation or joint mobilization? Of course not! Could a tech be

> trained

> to administer ultrasound, iontophoresis or apply electrodes? Of

> course they

> could. Could a tech count repetitions of SLRs, QS, or shoulder

> pulleys?

> I'm thinking, yes. I understand that " if you give some people and

> inch,

> they will take a mile. " That is human nature. Is it right? NO.

> Should we

> all put shackles on ourselves to prevent the bad ones from taking

> over the

> world? I think not. Guys, all I am saying is let's not add more

> burdensome regulations to an already over-regulated industry. If the

> guys

> down the street are doing a bad job by using techs improperly, then

> dedicate

> your efforts to doing a better job. The best revenge is to flourish

> and

> prosper. Some advice from an old-timer.

>

> Rob Jordan, PT, MPT, GCS, OCS

>

> _____

>

> From: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

> [mailto:PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com>

> ps.com] On

> Behalf

> Of Ron Barbato

> Sent: Friday, May 02, 2008 9:03 AM

> To: PTManager@yahoogrou <mailto:PTManager%40yahoogroups.com> ps.com

> Subject: RE: Re: So we can use techs or aides to perform

> part of

> our treatment? (Not medicare)

>

> My concern with this thread is the terminology - delegated duties,

> with

> established competency "

> Are we saying that skilled PT interventions can be " learned on the

> job "

> Fellow colleagues, that is a very slippery slope with significant

> implications

> Use of non licensed aides to perform skilled billable physical therapy

> service is unacceptable.

>

> Ron Barbato PT

> Administrative Director, Rehabilitation Services

> Ephraim McDowell Health

> Voice:

> Fax:

> HYPERLINK " mailto:rbarbato%40emrmc.org " rbarbatoemrmc (DOT) -org

> Member, KY Board of Physical Therapy

>

> PRIVILEGED AND CONFIDENTIAL: This transmission may contain information

> that is privileged subject to attorney-client privilege or attorney

> work

> product, confidential and/or exempt from disclosure under applicable

> law. If you are not the intended recipient, then please do not read it

> and be aware that any disclosure, copying, distribution, or use of the

> information contained herein (including any reliance thereon) is

> STRICTLY PROHIBITED. If you received this transmission in error,

> please

> immediately advise me, by reply e-mail, and delete this message and

> any

> attachments without retaining a copy in any form. Thank you.

>

> Re: So we can use techs or aides to perform

> part of

> our treatment? (Not medicare)

>

> - Ssate practice acts governing the rules and laws of PT

> differ greatly in that respect. However, over the last two decades,

> states have generally become more restrictive on delegation issues,

> following the lead of the APTA, which supports only the PT and the

> PTA are the only providers of physical therapy services. Here is a

> link from the Federation showing a state by state guide of this:

> HYPERLINK

> " http://www.fsbpt. <http://www.fsbpt.org/RegulatoryTools/ReferenceGuide/

> >

> org/RegulatoryTools/ReferenceGuide/ " http://www.fsbpt.

> <http://www.fsbpt.-org/> -org/

> RegulatoryTo-ols/ReferenceGui-de/

>

> Don Walsh, PT, MS, OCS

> Gainesville GA

>

> >

> > Why does the Florida practice act appear to allow us

> > to delegate portions of treatment to aides and bill

> > for it? This is the " excemptions " section, please not

> > excemption (3). If an employer references this and

> > argues that an athletic trainer, or even a PT aide can

> > be trained by a PT to assist in the clinic for

> > non-medicare patients, how does a PT manager or PT

> > counter this point?

> >

> > 486.161 Exemptions.---

> >

> > (1) No provision of this chapter shall be construed

> > to prohibit any person licensed in this state from

> > using any physical agent as a part of, or incidental

> > to, the lawful practice of her or his profession under

> > the statutes applicable to the profession of

> > chiropractic physician, podiatric physician, doctor of

> > medicine, massage therapist, nurse, osteopathic

> > physician or surgeon, occupational therapist, or

> > naturopath.

> >

> > (2) No provision of this chapter shall be construed

> > to prohibit:

> >

> > (a) Any student who is enrolled in a school or course

> > of physical therapy approved by the board from

> > performing such acts of physical therapy as are

> > incidental to her or his course of study; or

> >

> > ( Any physical therapist from another state from

> > performing physical therapy incidental to a course of

> > study when taking or giving a postgraduate course or

> > other course of study in this state, provided such

> > physical therapist is licensed in another jurisdiction

> > or holds an appointment on the faculty of a school

> > approved for training physical therapists or physical

> > therapist assistants.

> >

> > (3) No provision of this chapter prohibits a licensed

> > physical therapist from delegating, to a person

> > qualified by training, experience, or education,

> > specific patient care activities, as defined and

> > limited by board rule, to assist the licensed physical

> > therapist in performing duties in compliance with the

> > standards of the practice of physical therapy.

> > Specific patient care activities, as defined and

> > limited by board rule, must be performed under the

> > direct supervision of the licensed physical therapist

> > or physical therapist assistant in the immediate area,

> > if the person is not a licensed physical therapist

> > assistant.

> >

> ____________-_________-_________-_________-_________-_________-_

> ____________-___

> > Be a better friend, newshound, and

> > know-it-all with Yahoo! Mobile. Try it now.

> HYPERLINK

> " http://mobile. <http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

> >

> yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ " http://mobile.

> <http://mobile.-y> -y

> ahoo.com/-;_ylt=Ahu06i62sR-8HDtDypao8Wcj9tA-cJ

> >

>

> ---------------------------------------

>

> In ALL messages to PTManager you must identify yourself, your

> discipline

> and your location or else your message will not be approved to send to

> the full group.

>

> PTManager encourages participation in your professional association.

> Join APTA, AOTA or ASHA and participate now!

>

> Visit the NEW and IMPROVED www.InHomeRehab.-com.

>

May 3, 2008

I disagree-we can't have practice acts being so specific as it will further

devalue and derail our attempt at autonomous providers. R Jordan's post was

right on.

Let me throw out an analogy. Years ago we had employee handbooks that were 3

inches thick as the industry tried to make a rule for every scenario out there.

As employment case law evolved, we were then instructed to do just the opposite.

Keep policies general and subject to interpretation and now our handbooks are

only a few pages.

Would a physician practice act list the delegated tasks that a nurse can do?

__________________________________________

Larry

Larry Benz

PT Development LLC

13000 Equity Place Suite 105

Louisville, KY 40223

larry@... (best way to reach)

mobile (Spinvox converts voice to email)

office

(Fax: only if you must)

LarryBenz MyPhysicalTherapySpace.com ID

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________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

keith bisesi

Sent: Friday, May 02, 2008 1:18 PM

To: PTManager

Subject: RE: Re: So we can use techs or aides to perform part of our

treatment? (Not medicare)

I agree. But that's the problem, there should not be

such left up to interpretation. They do exactly what

you mention. They state skilled PT interventions can

be learned on the job (if the therapist thinks it is

adequate). Our laws and rules in each state should

specifically state " an aide cannot be utilized to

perform a-b-c.. " My Florida practice act specifies

what aides cannot do, but treatment is not one of

them. The duties that are specifically excluded for

aides do not mention treatment. So basically an aide

can perform any duties that a PTA can if trained on

the job. Unfortunately there are many therapists who

will use an aide beyond modality setup. If we use

aides for therapeutic exercise or manual therapy, we

are no different than a chiropractor using a

chiropractic assistant to provide billable services,

or an MD wanting to use a medical assistant or

athletic trainer. Our act needs to be amended.

Bisesi MPT COMT

Winter Haven, Fl

--- Ron Barbato <rbarbato@... <mailto:rbarbato%40emrmc.org> > wrote:

> My concern with this thread is the terminology -

> delegated duties, with

> established competency "

> Are we saying that skilled PT interventions can be

> " learned on the job "

> Fellow colleagues, that is a very slippery slope

> with significant

> implications

> Use of non licensed aides to perform skilled

> billable physical therapy

> service is unacceptable.

>

> Ron Barbato PT

> Administrative Director, Rehabilitation Services

> Ephraim McDowell Health

> Voice:

> Fax:

> rbarbato@... <mailto:rbarbato%40emrmc.org>

> Member, KY Board of Physical Therapy

>

> PRIVILEGED AND CONFIDENTIAL: This transmission may

> contain information

> that is privileged subject to attorney-client

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>

> Re: So we can use techs or

> aides to perform part of

> our treatment? (Not medicare)

>

> - Ssate practice acts governing the rules and

> laws of PT

> differ greatly in that respect. However, over the

> last two decades,

> states have generally become more restrictive on

> delegation issues,

> following the lead of the APTA, which supports only

> the PT and the

> PTA are the only providers of physical therapy

> services. Here is a

> link from the Federation showing a state by state

> guide of this:

> http://www.fsbpt.org/RegulatoryTools/ReferenceGuide/

<http://www.fsbpt.org/RegulatoryTools/ReferenceGuide/>

>

> Don Walsh, PT, MS, OCS

> Gainesville GA

>

> >

> > Why does the Florida practice act appear to allow

> us

> > to delegate portions of treatment to aides and

> bill

> > for it? This is the " excemptions " section, please

> not

> > excemption (3). If an employer references this and

> > argues that an athletic trainer, or even a PT aide

> can

> > be trained by a PT to assist in the clinic for

> > non-medicare patients, how does a PT manager or PT

> > counter this point?

> >

> > 486.161 Exemptions.--

> >

> > (1) No provision of this chapter shall be

> construed

> > to prohibit any person licensed in this state from

> > using any physical agent as a part of, or

> incidental

> > to, the lawful practice of her or his profession

> under

> > the statutes applicable to the profession of

> > chiropractic physician, podiatric physician,

> doctor of

> > medicine, massage therapist, nurse, osteopathic

> > physician or surgeon, occupational therapist, or

> > naturopath.

> >

> > (2) No provision of this chapter shall be

> construed

> > to prohibit:

> >

> > (a) Any student who is enrolled in a school or

> course

> > of physical therapy approved by the board from

> > performing such acts of physical therapy as are

> > incidental to her or his course of study; or

> >

> > ( Any physical therapist from another state

> from

> > performing physical therapy incidental to a course

> of

> > study when taking or giving a postgraduate course

> or

> > other course of study in this state, provided such

> > physical therapist is licensed in another

> jurisdiction

> > or holds an appointment on the faculty of a school

> > approved for training physical therapists or

> physical

> > therapist assistants.

> >

> > (3) No provision of this chapter prohibits a

> licensed

> > physical therapist from delegating, to a person

> > qualified by training, experience, or education,

> > specific patient care activities, as defined and

> > limited by board rule, to assist the licensed

> physical

> > therapist in performing duties in compliance with

> the

> > standards of the practice of physical therapy.

> > Specific patient care activities, as defined and

> > limited by board rule, must be performed under the

> > direct supervision of the licensed physical

> therapist

> > or physical therapist assistant in the immediate

> area,

> > if the person is not a licensed physical therapist

> > assistant.

> >

>

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>

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May 3, 2008

Hi Rob,

I wish I could lighten the discussion but I have no profound words to do

that today. It is easy to get discouraged by a wacky system of

reimbursement that requires us to follow wacky rules. I know I have asked

myself on more than one occasion if it is worth it. I wish that I could

lessen that discouragement that I feel in your posts but I can't.

I always have to be reminded, (as I was just recently on the discussion on

CPT codes) of the amount of time and hard work by our colleagues and peers

on the things that make up our every day practice. Ethics and rules are

there to protect the public we serve. The ethics and rules we try to follow

have been debated and discussed for years by people from all backgrounds and

all experiences in PT. These rules were not arrived at lightly and are

continually being reviewed as our practice changes. Most of the rules and

ethics required by insurances, including Medicare, mirror what the APTA has

set forth. But again, these rules and ethics are there to protect the

public, as they should. SO.we have controlled our own destiny by arriving

at rules and ethics set forth by our own peers.

Ethics are " high and mighty " and they should be. We serve the public and

they should be afforded every protection we can give them including the best

practice standards we can create. If only the public understood the

dedication and hard work and attention to ethical treatment that we have

worked on, they could plainly see what sets us apart from the personal

trainer who spent two hours online and get a certification and has no

standards or ethics in place to protect anyone!

Follow the rules and ethics, don't follow the rules and ethics, that is your

choice as is your choice to accept insurances or treat on a cash only basis.

You can disagree all you want but I will continue to let you and this

listserve know that you can follow the rules and ethics and still have a

successful profitable practice.

Tom Howell, P.T., M.P.T.

Howell Physical Therapy

Eagle, ID

howellpt@...

_____

From: PTManager [mailto:PTManager ] On Behalf

Of Jordan

Sent: Friday, May 02, 2008 8:40 PM

To: PTManager

Subject: Re: Re: So we can use techs or aides to perform part of