ADVANCE Perspective: Physical Therapy : Ethics & Legal Issues

CT Nursing Home Lawsuits Involve Lack of PT

Lauren Fritsky — Mon, 15 Jun 2009 15:31:00 GMT

There's an interesting story out of Connecticut from this weekend. It involves a nursing home facing lawsuits for neglecting two patients, both of whom died. In the first, part of the argument is that the client did not receive "medically necessary physical...(read more)

PTs Making Progress

Rob Senior — Tue, 26 May 2009 20:12:00 GMT

Earlier this week, 200 physical therapists, PTAs and students of physical therapy programs went to Capitol Hill to speak with legislators about the need to improve patient access to physical therapy services. Once in meetings with Senate and House members,...(read more)

Compensated for Cancer?

Elizabeth Puliti — Tue, 17 Mar 2009 00:16:00 GMT

The International Agency for Research on Cancer (IARC), part of the World Health Organization, concluded in 2007 that night work is "probably carcinogenic to humans." Furthermore, the IARC classifies the cancer risk of night work as "Group 2A," the same group as tanning beds-and only one group below asbestos and mustard gas.

According to CNN, employers in Denmark are paying compensation to women who developed breast cancer after working night shifts:

Thirty-eight eight women have so far received payments via their employers' insurance companies, the Danish National Board of Industrial Injuries told CNN.

To qualify for compensation, women must have developed breast cancer after having worked at least one night shift a week for 20 to 30 years.

The amount of compensation depends on the severity of claimants' illness and their ability to work.

This article got me thinking. Would this ever happen in the United States? Do you think health care providers--or anyone who works night shifts--would get compensated for cancer linked to night shift work?

You can read the whole article here.

Are Changes Coming?

Lisa Lombardo — Thu, 06 Nov 2008 19:51:00 GMT

America has elected a new president--an historic event that even other nations are taking notice of. Sen. Barack Obama's election as the first African-American president will rightly be remembered as a turning point in U.S. politics. But without too much prognostication, how will his election affect changes to health care policies? And specifically to issues affecting the physical therapy profession?

As we reported in our Sept. 22 issue previewing the election, the largest component of President-elect Obama's health care plan is his commitment to making affordable health care coverage available to all Americans. This includes 46 million--at least 8 million of whom are children. According to his campaign statements, under Sen. Obama's plan all Americans will be afforded the opportunity to buy a plan--at affordable rates--that mirrors the Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. No American will be turned away from Sen. Obama's plan due to pre-existing diseases or conditions. The plan will cover all essential medical services, even such instances as maternity and mental health.

Aside from major health insurance changes, will the Democrat-majority Congress now decide to make changes to the top issues affecting PT: getting rid of the caps on outpatient therapy under Medicare, pursing a plan for direct access to PT under Medicare or holding the physician fee schedule at its current rate?

What do you think? Will Democrat-managed decisions on Medicare make a difference in the next four years?

Don't Miss It!

Elizabeth Puliti — Wed, 05 Nov 2008 15:33:00 GMT

From November 5 - 8, Orlando, FL, will host APTA's 2008 Private Practice Section Conference. This year's theme is "Capturing the Magic of Business Success."

According to James E. Glinn, Sr., PT, owner and founder of FutureRehab, LLC in Bakersfield, CA, this year's not-to-be-missed events include:

Early pre-conference workshops, including legal issues and how to implement employer-paid industrial services;
Educational sessions each day, running the gamut from reimbursement/retention of professional staff to the latest on information technology systems implementation;
In-depth educational sessions focusing on such subjects as "Building Bone Health into Your Practice" as well as methods on increasing "Business Profitability and Autonomy";
Intensive educational sessions including 3-hour presentations on "A Twelve Month Plan to Managing Your Practice," "Boosting Direct Access Through Wellness and Non Physician Referrals, Direct Marketing and Brand Identity" and "Succession Planning Foster Practice Success: Your Five Year Plan."

The conference is sure to profit physical therapists, business managers, marketing personnel and other healthcare professionals.

For more information on how to get the most from the conference, click here.

For the 2008 PPS conference schedule-at-a-glance, click here.

Good News: Senate Passes Medicare Bill

Lisa Lombardo — Thu, 10 Jul 2008 19:23:00 GMT

Pleasing the leadership of the American Physical Therapy Association and PTs and PTAs everywhere, the Senate yesterday passed HR 6331, the Medicare Improvements for Patients and Providers Act.

"We are thrilled that the Senate took action yesterday and passed [the bill]," said APTA president R. Scott Ward, PhD, PT, in a statement. "The senators obviously heard from beneficiaries and providers in their states and recognized the need to take this action to protect Medicare beneficiaries who need rehabilitation services the most-seniors and persons with disabilities.

"This legislation, which includes provisions essential for Medicare beneficiaries to maintain access to needed services, now awaits the President's signature. The APTA urges President Bush to take immediate action and sign this critical bill into law to protect the quality of life and well-being of millions of Americans," Dr. Ward stated.

"Provisions in HR 6331 are critical to avoiding the unsustainable cuts in Medicare payments to physical therapists and to restoring the therapy cap exceptions process that assures that beneficiaries who qualify for the exception will continue to get the crucial therapy care they need," Dr. Ward said.

Other key provisions will delay competitive bidding for durable medical equipment, prosthetics, orthotics, and supplies and restore important payment protections for rural providers.

The signing extinguishes what were growing worries of the APTA that Congress might not make a decision on the Medicare cap on outpatient therapy exceptions process. As of July 1, the exceptions process under the cap ($1,810 for PT and speech therapy combined; the same amount for OT) had expired. Therapists submitting under Medicare for patients who needed the cap exception the most-those recovering from stroke, traumatic brain injury and other long-term conditions-would have had to get a lot more creative in helping their patients continue with necessary therapy.

On a personal note, I know of several people close to my family and friends who have loved ones who had a stroke or were auto accident victims who would qualify for Medicare and will need ongoing therapy. For therapists out there, did the exceptions cap "close call" adversely impact you and your patients?

Physical Agents: In or Out?

Lisa Lombardo — Wed, 25 Jun 2008 19:29:00 GMT

Since becoming the editor of ADVANCE in 2000, the thought has often occurred to me that PTs and PTAs are a surprisingly well-informed and opinionated bunch.

But they are also a lot of fun as well.

This was proved to me on June 13 at the annual APTA conference in San Antonio, as APTA premiered its first Oxford Debate. PT experts on both sides considered whether physical modalities that might not be based on evidence should be used and billed by PTs. Despite the seriousness of the topic, the therapists on hand made being confined to a conference room on a gorgeous sunny day in Texas more entertaining than can be expected!

The debate addressed the question: Should physical therapists remove the use and billing of selected (infrared, laser, diathermy, thermal agents) physical agents from their practice?

The idea behind the debate was to question the appropriateness of the removal or maintenance of use of these interventions, the impact of them on current practice, and how removal of them would affect PT's image and independence as a professional body.

An Oxford debate is similar to British Parliamentary debate, pitting two teams of three making the arguments both for and against the question. Each team selects an opening speaker, a second "rebuttal" speaker and a third "summator" speaker for their respective arguments, and the audience comprises the "floor," allowed to ask questions of each panel before the summator speakers wrap up. Competitors are encouraged to maintain civility but also to debate with "animation, passion and creativity," according to traditional Oxford rules. And the PT panelists certainly rose to the challenge.

The debate was lively, fun and inciteful (thanks to the participants!). In a unique twist, whenever one side gave an argument, the audience could move from one side of the room to the other to show their support for the stated argument. There was a lot of up and down as many therapists switched sides.

This struck me as particularly interesting, because it showed how complex the issue really was. More than one debate attendee mentioned that professional credibility for PT could be at stake if PTs turn too often to unproven agents for treatment.

Should PTs use modalities in the clinic-and bill for them-when patients can find hot packs and other agents in drug stores and use them at home? How much should therapists rely on physical agents when there is little to no solid evidence that they work in the long-term? Are therapists just billing, in effect, for placebos? Or are therapists wrong to reject agents that might work well for their patients' rehab?

What do you think about using physical agents? Do you use them, and how? Do you feel other therapists might rely on them too often?

Bridging the Gap

Elizabeth Puliti — Fri, 13 Jun 2008 16:44:00 GMT

SAN ANTONIO—This morning's session "Generational Ethics: Bridging the Gap From Traditionalists to Millennials" was one of the most interesting lectures I've attended at an APTA conference. Maybe it was because it wasn't really a lecture. PTs were encouraged to sit at round tables in the room and discuss issues among themselves. Maybe it was because this is such a hot topic in any work environment now. I see numerous examples of generational differences even within my publishing company. Or maybe it was because the audience consisted of PTs spanning all generations. This made for interesting case study solutions!

Whatever the reason, I learned a great deal about the four or five generations (Generation Y is split between Generation X and the Millenials) that currently work together and how they/we think.

Traditionalists (born roughly between 1900 and 1942), also known as "the greatest generation," overcame the economic depression, are very civic-minded and masterfully raised the next generation, which turned out to be the largest. Baby boomers (born from 1946 to 1964) were encouraged to dream big, and were born during the largest economic growth period. Generation Xers (born between 1965 to 1982) grew up living in the shadow of the boomers. They have what speaker Jon T. Nordrum, PT, DPT, DScPT, GCS, from the Mayo Clinic called, "the middle-child syndrome."

"This generation gave us the term latch-key kids because it was the first time in history that elementary-aged children were coming home to empty houses," he said. Because of that--as well as seeing military failure (we lost a war), political failure (a president was impeached) and economic failure--this generation became survivor-based.

Millenials (born approximately from 1982 to 1997) are nurtured, have parents who are strong advocates for them and have instant access to information because of the Internet.

Dr. Nordrum made it a point to tell the audience of PTs "it is more about how the generation thinks, feels and acts together and less about the date."

Because each generation has different values, conflicts ultimately arise in the work environment. In order to find balance in the workplace and provide optimal care for patients, change must occur, Dr. Nordrum advised. He and other PTs recommended the following:

Be sure to have an open-door policy where everyone is welcome to discuss their thoughts;
Establish mentoring relationships;
Evolve with technology;
Play to the strengths of all generations.

However, some generations, such as boomers, are embracing new values, an audience member pointed out. Dr. Nordrum agreed. "Boomers may be jealous of Xers work-life balance. They were smart enough to ask for it up front, and it's taken us all these years," he mused.

No matter their value differences--and they are just differences ("they're not better, not worse, just different from one another," Dr. Nordrum said)--it is obvious the collaboration of all generations is what creates the best possible team. This was particularly apparent at the end of the first hour when Dr. Nordrum put out a call to any Generation Xers or Millenials in the audience who could help him stop a message from popping up every few minutes during the power point presentation.

Did PTs Get Their Wish in the New Year?

Lisa Lombardo — Thu, 10 Jan 2008 16:31:00 GMT

Last June at the APTA Annual Conference, representatives from the government affairs section gave their annual overview of legislative issues directly affecting the PT profession. The session evolved into sort of a "wish list" of priorities that the profession's leaders wanted to see resolved by the end of 2007.

These included legislation on the physician fee schedule and avoiding a projected increase of almost 10 percent, an extension of the physician quality reporting initiative (PQRI) as it stood, and-failing a repeal of the $1,780 Medicare cap on outpatient therapy entirely-an extension of the therapy cap exceptions process.

In the last few weeks of 2007, the APTA got what it wished for-sort of. The 2008 Final Physician Fee Schedule rule was issued on Nov. 1, 2007. But for the next month and a half, there was little Congressional movement on any of the Medicare measures until a bill was proposed in the Senate on Dec. 18. 2007. The Medicare, Medicaid and SCHIP Extension Act of 2007 (S. 2499) was passed and then signed by President Bush on Dec. 29, 2007.

According to the APTA (http://www.apta.org/), several key provisions were included:

Extension of the therapy cap exceptions process through June 30, 2008; the 2008 therapy cap is now set at $1,810.

An increase in the physician payment rate; extension of the PQRI. This replaces the scheduled 10.1 percent cut to the Medicare physician reimbursement rate in 2008 with a 0.5 percent increase through June 30, 2008.

Extension of the floor on work geographic adjustment. Extends the work geographic index (GPCI) floor of 1.0 through June 30, 2008.

Payments for inpatient rehabilitation facility (IRF) services. Permanently freezes the IRF services compliance threshold at 60 percent. Sets the market basket update factor at 0 percent from April 1, 2008, through FY09.

Reauthorization of SCHIP to March 2009.

Back in June, the hope from lobbyists was that the fee schedule would not see the drastic percentage cut, and that seems to have been avoided. The organization also hoped for a year-long extention on the exceptions process. The legislation most certainly helps avoid major patient care problems and cutbacks for PTs. The cap still exists-but perhaps PTs have now found innovative ways to make it work for their most needy patients.

What do you think of the measures only effective until June of this year? Do these legislative outcomes work for the profession for now? And are there still PTs out there who are optimistic that the therapy cap will be repealed someday?

Issues of Infringement

Lisa Lombardo — Fri, 26 Oct 2007 13:56:00 GMT

A recent guest editorial was sent to ADVANCE discussing the subtle encroachment of personal trainers into the domain of the physical therapy profession (ADVANCE, Oct. 22, 2007). The writer expressed concern that personal trainers were staking claim to strength training and exercise rehab expertise that should remain the proper scope of practice for PTs and PTAs.

The notion is not a paranoid one; despite the best intentions of therapists to educate and even of many personal trainers to represent themselves accurately, patients and clients who seek expertise on strength training and exercise for therapy can become genuinely confused when considering who to ask as an expert in this area.

The American Physical Therapy Association takes a proactive stand on lobbying for decisions in state PT practice acts-and the practice acts of many other professions-to fight infringement cases that endanger PTs.

There are many documented cases of possible encroachment on the PT profession, most notably in legal decisions on the advertising methods and practice acts of chiropractors, exercise physiologists and athletic trainers. These professions are, arguably, somewhat similar in educational requirements and training, albeit not nearly as comprehensive as that of physical therapists. But the same cannot be said for personal trainers. Most of those programs require a much smaller amount of education to earn certification to begin legitimate practice in that field.

Have you had an experience with fighting encroachment between personal trainers who bill themselves as "PTs"? Do you feel this issue presents a looming problem for the profession?