Don’t Tell Me to Ignore the Practice Act
I heard something today I just couldn't believe. I was talking to the department manager about who is responsible for putting patients back to bed. My point was in order for physical therapy to be physical therapy, a skilled intervention must be involved. The intervention must be goal driven toward a functional outcome. I've said this before. What took my breath away was his response. I was told he didn't care about the practice act or what is functional. Nursing is short staffed. If nursing asks me to put a patient back to bed I am to do it and do it with a smile on my face. He went on to acknowledge that was a job duty of a CNA. He told me charges don't matter because our reimbursement is DRG driven. He only cares that the patient be happy and willing to return to the facility. If good patient care means I put the patient back to bed, I should put the patient back to bed.
I have no problem with providing good patient care. I go out of my way to take care of my patients. My problem is being told I should disregard the document which governs how I practice. My problem is being told to perform non-skilled interventions because nursing is telling me to do so. I have a problem when the department carries patients on caseload for the sole purpose of lifting them out of bed and charging that as a skilled service. That is called fraud. Not only does Medicare frown on that, it is illegal.
I don't know what to think. Physical therapy has spent years educating other health care professionals on what we do. PTs are recognized for their skills in treating neuromuscular disorders. That is one of the principles behind the push for the DPT. For a fellow PT to tell me to ignore the practice act is beyond me. If I practice outside the practice act, I lose my license. If I provide unskilled services and charged them as skilled services, I am committing fraud and can not only lose my license, but go to jail.
It would be one thing if he told me to suck it up because that is department policy. I wouldn't be happy, but it wouldn't be heresy. This man has gone so far to the dark side even he makes Darth Vader seem good. At least Darth had principles. It doesn't matter to me that this situation isn't a frequent occurrence. It's going to happen. When it does, I deal with it. What matters is that this manager equated what I do with what a CNA does. Instead of defining our profession, he let us down.
I don't know what to do. Up until today, I enjoyed working at that facility. I'm not fond of the man, but respected his position. Now I'm not sure he deserves his position. I can report him to the Texas board, but I don't think anything will result. Since no one else heard him, it's my word against his and I doubt they'll act on that. I can ask to be transferred, which gets me away from the problem. I can go to his superior, but I suspect an administrator would be more concerned about the patient coming back then this. No matter what, I'm not going to do what he said. I can only be responsible for myself. When I find myself in this situation, I'll find an acceptable way to deal with it that makes the patient happy and is within the practice act.