Ethics and Dealing with Consultants

re: Ethics and Dealing with Consultants

Tim Banish — Wed, 27 May 2009 23:37:48 GMT

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!!

re: Ethics and Dealing with Consultants

Jennifer — Thu, 21 May 2009 02:33:36 GMT

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.

re: Ethics and Dealing with Consultants

Louise — Wed, 29 Apr 2009 03:36:17 GMT

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.

re: Ethics and Dealing with Consultants

Susie Q OT — Tue, 28 Apr 2009 23:56:29 GMT

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.