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COTA Thoughts

Ethics and Dealing with Consultants

Published April 18, 2009 5:12 PM by Tim Banish
            This week has been a challenging one for the therapy team I work with. We currently have a team of consultants reviewing our patient caseload and the therapy minutes being delivered. They then recommend ways to maximize profits. All of this is well and good, with the exception that some (well, most) of their recommendations are unethical.

            The consultant team consists of nurses who have been trained in MDS applications and projections. There are no therapists on this team, and to my knowledge not one member has been a therapist in the past. Their primary job is to review progress and rehab team meeting notes, including e-mails between the MDS team and therapy staff, then recommend therapy goals to increase company profits. Or in my words "grab as many dollars from Medicare as they can figure out how to".  Now I realize that making a profit is a necessity of business or else the business will close. A profit I can agree with, but ethically I can not agree with the use of the therapy team as a money making machine. As a therapy team, we strive to deliver services that are appropriate for each patient and discuss as a team the best plan for each patient when that person has reached their potential.

            The real concern here is the consultants' recommendations have included continuing therapy with some people who have reached their maximum potential. They have also recommended initiating therapy with some people who are not appropriate. It seems like they are reading between the lines on the evals, progress notes, screens, and other correspondence, and then recommend therapy goals in an effort to gain additional minutes. One such instance is the person who has severe dementia but can dress and bathe independently and safely with just verbal cues to initiate. This person was evaluated for their cognitive retention skills, which is documented to prove that information presented is forgotten in less than one minute. With this short of a memory span it is very unlikely that any new information will be retained, such as initiating self dressing and bathing on a daily basis. Additionally, as dementia is a progressive disease, the retention of any new information will only decrease even further in the future. The consultants' suggestion was to provide this person with therapy in order to have them initiate ADL's on a daily basis. HUH??!!?? As I said, their reading of evals and notes seem to be quite patchy, only finding information they want to in order to "suggest" therapy goals.

            This leads to another ethical issue I struggle with. Who is appropriate to recommend therapy goals? Well, when it's my license on the line the only answer I'll give you is my supervising OTR. Risking the loss of my therapy license jeopardizes my career and livelihood, and there is no way I'm allowing that to happen. Nurses, consultants and/or family members do not have the education required to establish therapy goals.

            One other issue with the consultants' presence is that we have spent so much time answering their questions that we have lost minutes with a few patients. Why does this seem like an oxymoron? They are there to maximize minutes yet deter us from doing our jobs.

            My final thought on this is my definition of the word consultant - A person who is designated to find someone else more work, despite the fact that they lack the knowledge base to do so, and while ignoring all ethical principles increase company profits so they can validate their hefty salary.

Until next time, hope all your "Thoughts" are Good-

Tim

4 comments

I never thought that out patient therapy would become selective to insurance coverage too. That is a real issue if some patients who need more therapy are getting cut out so a therapist can attend to a patient with a better insurance regardless of their condition. The corporate world and their greedy ways make me sick. Worse than that, the corporate consultants are BACK!!

Tim Banish, LTC - COTA/L May 27, 2009 7:37 PM
Cincinnati OH

I am facing ethical issues in out-pt. therapy as well.  My company wants the level of therapy to be based on the patient's insurance rather than the diagnosis or patient's needs.  So, if a person with the better insurance has a minor injury my company wants us to tx them for 4 units, verses someone with bad insurance and a severe injury will only be scheduled for 2 units.  As an ethical therapist who values her license more than her job I tx the patient appropriately.  I understand the company wants to make money.  So do I.  But not at the expense of someone's ability to return to work or perform self care tasks.

Jennifer, Out Patient - OTR May 20, 2009 10:33 PM
FL

Welcome to the real world of SNF therapy!  What you describe has been the rule, not the exception, in the years since SNFs figured out how to milk the PPS.  You are lucky you are just now getting it.  Example:  I walked in to a building a couple months ago as a registry COTA.  I had 4 hours and was given 390 minutes of therapy.  That's my most extreme example, but it's not far off the every day experience, at least here in Arizona.

I understand your point about non-therapists coming in and dictating, but in my experiences, therapists do it themselves all the time...gotta get those Ultra Highs on everybody!  So I am now out of the SNF business completely--I now work for an LTACH.  No more RUGS.

Louise, , COTA various April 28, 2009 11:36 PM
Phoenix AZ

Your frustrations are loud and clear!  I think they are shared by many.  I do think though, that getting feedback like that can be important in helping therapists reflect upon their skills and the services they provide.

There have been many patients I have worked with who have had a stroke that have been told by other clinicians they had met their 'max potential', and my skill set for intervention was such that I was able to take them further.  I have learned that my reason for discontinuing services is NEVER 'max potential reached'.  Instead, I use 'no further significant progress'.  There are a lot of therapists who posess even better skills than I do, who may be able to take the patient even further.

Likewise, 10 yrs ago, I did not posess the skill set I have now when it comes to working with dementia clients.  I have learned so much on environmental modification, that in situations such as you have described, OT skills in environmental modification can often facilitate task initiation based upon the visual cues in the environment alone.

I tend to view consultants as people to are analyzing a situation and putting their two cents in.  I may not agree with them and dont have to...  but I think it may be worth reviewing with your supervisor, and or meeting with the consultants and asking them pointed questions....  "what are you seeing regarding this person that thinks they will be able to retain new strategies?"  Are they trying a new dementia med?   Maybe it would be worth a reassessment of their cognition.  People with dementia can learn! (Just put on a tab alarm, it isnt long till they learn how to remove it!  haha)

Yeah, if there are things I could do better, I want to learn more and do it for the clients sake and quality of life.  Yes, therapy is an avenue for cash flow, but if we do all we can clinically, bill appropriately for the skilled services we are providing, I really dont know what else one can do in these types of situations.

If I were in your shoes, I wouldnt be so quick to get frustrated.  I would take it as an opportunity to review and ask questions of the consultants.   Who knows.. maybe they have some good resources or other places they have been that can be of benefit to you.   If they fumble the ball when replying to you..  you may want to suggest to them that they include a therapist on their team who could aid them in providing more concise insight.

Susie Q OT, Geriatrics - OT, Long Term Care April 28, 2009 7:56 PM
Midwest

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