Guest guest Posted July 24, 2012 Report Share Posted July 24, 2012 Unfortunately the concept of other disciplines mobilizing patients seems to be something we all struggle with. I don't understand why linking increased mobilization vis a vis using more than just PT, leading to reduced LOS and cost is such a difficult concept to understand or put into action. Theresa M. Morrone PT, MS, CCS Director, Physical Therapy NewYork Presbyterian Hospital/ Columbia University Medical Center 180 Fort Washington Ave Rm 170 New York, NY 10032 Tel Fax ________________________________ From: PTManager [PTManager ] on behalf of Eileen Casey [ecasey@...] Sent: Tuesday, July 24, 2012 9:21 AM To: PTManager Subject: observation patient denials How are those in acute care dealing with observation patients and orders for PT/OT? We are getting an influx of patients admitted with dehydration, hyponatremia, failure to thrive, confusion etc and PT is being ordered almost on admission rather than rehydrating, normalizing electrolytes etc and seeing if the patients returns to their baseline function. We have been struggling trying to educate the docs and nurses that it is not solely PT that can get patients out of bed and walking. Has anyone found an effective strategy for dealing with this? Has anyone developed an algorithm that would help guide MDs in their orders? Any suggestions would be appreciated. Eileen Casey, PT Director Rehabilitation Services Brattleboro Memorial Hospital 17 Belmont Ave Brattleboro, VT 05301 (P) (F) ecasey@...<mailto:ecasey%40bmhvt.org> __________________________________________________________ The information contained in, or attached to, this e-mail, may contain confidential information and is intended solely for the use of the individual or entity to whom it is addressed and may be subject to legal privilege. If you have received this e-mail in error you should notify the sender immediately by reply e-mail, delete the message from your system and notify your system manager. Please do not copy it for any purpose, or disclose its contents to any other person. The views or opinions presented in this e-mail are solely those of the author and do not necessarily represent those of the company. The recipient should check this e-mail and any attachments for the presence of viruses. The company accepts no liability for any damage caused, directly or indirectly, by any virus transmitted in this email. __________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2012 Report Share Posted July 24, 2012 We control this in two ways. First, as a preventative, we have explained to the docs that these patients are outpatients, so they incur fees rather than having their therapy buried in a DRG rate, they require certain sorts of documentation exceeding that of typical inpatients that at least minimally burdens the docs, they require consents not covered by the standard inpatient observation care consents, and that if the therapy is necessary for any term longer than the observation stay, the entire thing will have to be redone anyway by either outpatient or home health services. The focus on the cost of unnecessary services has tended to minimize the referrals. The second way we control them is by explaining the whole thing again in the instance of a referral, only with the patient's name in the blanks. This approach, while time consuming, has been pretty effective, and has provided long-term benefits. When a bad referral manages to sneak its way past our defenses, we follow through with it, occasionally without charge if it's particularly flagrant, figuring that the patient should not have to bear a financial burden for unnecessary care. The latter is a rare occurrence. Dave Milano, PT Rehabilitation Director Laurel Health System ________________________________________ From: PTManager [PTManager ] On Behalf Of Eileen Casey [ecasey@...] Sent: Tuesday, July 24, 2012 9:21 AM To: PTManager Subject: observation patient denials How are those in acute care dealing with observation patients and orders for PT/OT? We are getting an influx of patients admitted with dehydration, hyponatremia, failure to thrive, confusion etc and PT is being ordered almost on admission rather than rehydrating, normalizing electrolytes etc and seeing if the patients returns to their baseline function. We have been struggling trying to educate the docs and nurses that it is not solely PT that can get patients out of bed and walking. Has anyone found an effective strategy for dealing with this? Has anyone developed an algorithm that would help guide MDs in their orders? Any suggestions would be appreciated. Eileen Casey, PT Director Rehabilitation Services Brattleboro Memorial Hospital 17 Belmont Ave Brattleboro, VT 05301 (P) (F) ecasey@...<mailto:ecasey%40bmhvt.org> __________________________________________________________ The information contained in, or attached to, this e-mail, may contain confidential information and is intended solely for the use of the individual or entity to whom it is addressed and may be subject to legal privilege. If you have received this e-mail in error you should notify the sender immediately by reply e-mail, delete the message from your system and notify your system manager. Please do not copy it for any purpose, or disclose its contents to any other person. The views or opinions presented in this e-mail are solely those of the author and do not necessarily represent those of the company. The recipient should check this e-mail and any attachments for the presence of viruses. The company accepts no liability for any damage caused, directly or indirectly, by any virus transmitted in this email. __________________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2012 Report Share Posted July 25, 2012 Eileen, We had similar issue a couple years back and it ended up being primarily one doc. I handled it by discussing with CEO and the MD that it was revenue losing practice to have PT involved while on OBS. The discussion did greatly reduce the frequency of those orders but never did eliminate them entirely. Just like other issues in Rehab it comes down to each of us educating/informing the other medical professional we work with what really is best practice. Gwilliam, PT, MHA, CWS Director of Rehabilitation Bowie Memorial Hospital > > How are those in acute care dealing with observation patients and orders for PT/OT? > We are getting an influx of patients admitted with dehydration, hyponatremia, failure to thrive, confusion etc and PT is being ordered almost on admission rather than rehydrating, normalizing electrolytes etc and seeing if the patients returns to their baseline function. > We have been struggling trying to educate the docs and nurses that it is not solely PT that can get patients out of bed and walking. Has anyone found an effective strategy for dealing with this? Has anyone developed an algorithm that would help guide MDs in their orders? Any suggestions would be appreciated. > > > Eileen Casey, PT > Director Rehabilitation Services > Brattleboro Memorial Hospital > 17 Belmont Ave > Brattleboro, VT 05301 > (P) > (F) > ecasey@... > > > _______________________________________________________________ > > The information contained in, or attached to, this e-mail, may contain confidential information and is intended solely for the use of the individual or entity to whom it is addressed and may be subject to legal privilege. If you have received this e-mail in error you should notify the sender immediately by reply e-mail, delete the message from your system and notify your system manager. Please do not copy it for any purpose, or disclose its contents to any other person. The views or opinions presented in this e-mail are solely those of the author and do not necessarily represent those of the company. The recipient should check this e-mail and any attachments for the presence of viruses. The company accepts no liability for any damage caused, directly or indirectly, by any virus transmitted in this email. > _______________________________________________________________ > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2012 Report Share Posted July 25, 2012 , Your recent blog post reports that Dr. Pyne, reported by NYT as a physical therapist who stated that no could return to play by season's end. Dr. Pyne is, in fact, a CHIROPRACTOR doing rehabilitation on . Please let it be known, and please encourage all PT's on this list serve, to write to the NYT to correct the story. Our profession should not be made to take the blame for the comments of a NON PHYSICAL THERAPIST. http://www.sportslabnyc.com/curr.php -- * M. Ball, PT, DPT, PhD, MBA, OCS* *Board Certified in Orthopaedic Physical Therapy* *Residency Trained in Orthopaedic Physical Therapy* Carolinas Rehabilitation, Orthopaedic Physical Therapy Residency Faculty NorthEast Rehabilitation, Staff Physical Therapist cell: Quote Link to comment Share on other sites More sharing options...
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