Re: Hospital Inpatient Acute Questions

May 28, 2012

In our acute care facility PT, OT and Speech Language Pathologists write plans

of care based on the patient's current functional level, prior functional level,

potential for improvement and anticipated disposition. The plan is reassessed

when the goals are met or every 7 days...for those long LOS patients. Some

patients are seen by PT BID, QD and others may be 4-6x per week. If a patient

is hopefully going to be discharged to the community, the patient is a high

priority for treatment sessions and may be seen BID; if d/c is to a skilled

nursing facility they may be seen QD. Patients who may be admitted to our IRF,

are seen at least daily, so they have the endurance to be successful when

admitted to the IRF. If the patient is not progressing toward goals then the

frequency may decrease. There are some MDs that push for more therapy than the

patient needs or benefits from, but on the whole, respect the therapists

decisions. We have not had any negative feedback from Joint Commission.

Frequently we have more volume of patients than we can see in a day, so the

bigger challenge from a regulatory and practice perspective, was having a plan

of care and frequency that we were not meeting, so having more flexibility has

made caseloads more manageable.

Brownrigg

Clinical Coordinator Rehab Services

Acute Care and Inpatient Physical Rehabilitation Therapies

PeaceHealth St. ph Medical Center

From: PTManager [mailto:PTManager ] On Behalf Of

Mark Dwyer

Sent: Friday, May 25, 2012 7:18 PM

To: PTManager

Subject: Hospital Inpatient Acute Questions

With the changes in healthcare and the reality that payment is remaining flat

(if we're lucky) or being reduced while our expenses continue to climb, we keep

saying in my facility (and I keep seeing in articles), " We can't keep treating

people the same way we did in the past, we have to think of something

different. "

To that end, in looking at hospital inpatient acute care, has anyone

implemented, or is contemplating implementing, a system whereby acute inpatients

are seen on a frequency determined solely by the PT? For example, in my facility

now we see every patient referred to us on a daily basis (post-op ortho patients

are seen BID) except on Sunday, with only very long term patients being seen on

a less frequent basis than daily.

What I'm curious to know from other hospital facilities is if you have changed

your system such that the therapist determines the frequency based upon the

patient's need, discharge status (home versus to SNF or IRF), and prognosis,

such that you may only be seeing some patients twice per week or three times per

week? If you have implemented something like that, what has been the outcome in

relation to patient progression, staffing requirements, physician relations,

Joint Commission compliance, etc.?

A more extreme question is if anyone has limited or eliminated the therapy

provided to acute inpatients who will be discharged to skilled nursing or

inpatient rehab facilities? If so, what has been the outcome of that change?

Mark Dwyer, PT, MHA

Olathe, KS

markdwyer87@...<mailto:markdwyer87%40me.com>

May 28, 2012

Outside of Ortho, we have always operated that way. If a physician doesn't like

the frequency selected, they might follow-up with the PT (or me, the manager),

but they pretty much accept what we recommend. If we miss the recommended visit

frequency (usually because patient unavailable or sick), it's not unusual for us

to get a complaint about it.

We don't see patients being discharged to SNFs or IRFs on the day of discharge,

except Ortho, where we change from bid to qd.

Dan Gaskell

Carilion Clinic

Roanoke, VA

>

> With the changes in healthcare and the reality that payment is remaining flat

(if we're lucky) or being reduced while our expenses continue to climb, we keep

saying in my facility (and I keep seeing in articles), " We can't keep treating

people the same way we did in the past, we have to think of something

different. "

>

> To that end, in looking at hospital inpatient acute care, has anyone

implemented, or is contemplating implementing, a system whereby acute inpatients

are seen on a frequency determined solely by the PT? For example, in my

facility now we see every patient referred to us on a daily basis (post-op ortho

patients are seen BID) except on Sunday, with only very long term patients being

seen on a less frequent basis than daily.

>

> What I'm curious to know from other hospital facilities is if you have changed

your system such that the therapist determines the frequency based upon the

patient's need, discharge status (home versus to SNF or IRF), and prognosis,

such that you may only be seeing some patients twice per week or three times per

week? If you have implemented something like that, what has been the outcome in

relation to patient progression, staffing requirements, physician relations,

Joint Commission compliance, etc.?

>

> A more extreme question is if anyone has limited or eliminated the therapy

provided to acute inpatients who will be discharged to skilled nursing or

inpatient rehab facilities? If so, what has been the outcome of that change?

>

> Mark Dwyer, PT, MHA

> Olathe, KS

> markdwyer87@...

>

May 29, 2012

With the exception of TJR patients (TID PT) we operate the same way as the

answer below.

I feel that patients either meet criteria for therapy services or they don't.

We reduce the frequency if the patient is having medical setbacks but usually we

just document that they were unable to participate that day vs. actually

reducing the frequency in the tx. plan. To help justify the need for IRF, we

see those patients daily.

A strategy to better utilize resources (therapy staff-expense) would be to

quickly achieve goals and discontinue the patient and/or work on reducing

unnecessary orders. Much easier said than done! We have been trying for years

to reduce the number of unnecessary therapy orders. We've had some success but

not as much as we would like.

Lori Stoddart, OTRL

Inpatient Therapy Manager

Physical Rehabilitation Services

Henry Ford Wyandotte Hospital

2333 Biddle Avenue

Wyandotte, MI 48192

734/246-8963

lstodda1@...

[cid:image003.jpg@...]

From: PTManager [mailto:PTManager ] On Behalf Of

Brownrigg, M

Sent: Monday, May 28, 2012 11:34 AM

To: PTManager

Subject: RE: Hospital Inpatient Acute Questions

In our acute care facility PT, OT and Speech Language Pathologists write plans

of care based on the patient's current functional level, prior functional level,

potential for improvement and anticipated disposition. The plan is reassessed

when the goals are met or every 7 days...for those long LOS patients. Some

patients are seen by PT BID, QD and others may be 4-6x per week. If a patient is

hopefully going to be discharged to the community, the patient is a high