Ethics and Dealing with Consultants
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