Don’t Tell Me to Ignore the Practice Act

This is my first time ever to enter a view on a blog. Have just recently begun viewing them, and wish they could be a resource for policy makers and administrators. Nevertheless, I walked away from Toni's post about "putting patients in bed..." (paraphrasing), and felt compelled to respond. After blundering my way through other blogs, I got back. So, I will agree that all too often a blanket "mobility" or "ROM" or "out-of-bed" directive will be written in physician's notes section of a chart, leading to sometimes inappropriate use of skilled therapies to do rote tasks which should be performed by trained support staff. That being said, it is our skilled eyes, hands, and ears that make the experience of getting in and out of bed a therapeutic experience and at least an educational experience. So -- I would look at where the "order" is coming from: If it is indeed coming from nursing or administrative staff asking for "team-playing" in the overall care of a patient, I agree with Toni whole-heartedly. Using skilled personnel for these purposes is just dumb -- poor management, except for rare occasions. Furthermore if that same administrative person is wanting to bill for these moments of filling in for short-staffed nursing as skilled care, by all means a report to the appropriate agency would be indicated.  However, If the order is coming from the physician's plan, requests, etc etc -- even if worded as a "screen" "out-of-bed" then our skilled services apply and should be billed. We all know that 90% of the time, our screens may as well be evaluations because we can gather as much information in the time purusing the chart and our brief meeting with the patient as we could in an official evaluation.  We also know that we can train and re-train nursing staff until the end of time on the proper techniques for safely, smoothly, and efficiently getting patients in/out of bed to little effect; and will have even lesser chance of ever conveying the concept of facilitating the patient when getting in and out of bed.  So, if a generalized "almost order" came from the physician -- take it and build a plan of some kind: restorative care or skilled care -- but build the plan, and bill for the eval. If just short staffed, a policy should be in place that says skilled care does not step in unless the need is emergent. The fact the man said "billing doesn't matter because everything is DRG driven" is disgusting! A prime example of how Medicare in it's infinite wisdom dictates practices which cloud the lines of various interventions and lumps people into diagnostic categories with outrageous expections for all providers to meet all needs within an inhumane budget. Which leads me to:

http://www.thepetitionsite.com/1/medicare-accountability-a-must-before-a-single-payer-system

Please view, sign, comment, and pass on. It is just a summary but we need to speak up before Medicare becomes the one and only. Thanks.

I don't think he's violating the practice act unless he's telling you to "bill" for it or account for it in your time somehow.  

I wouldn't have a problem with this as long as it was recognized that this is not skilled intervention and that it does not affect any productivity standards that are placed upon me.  

If he told you to do this, account for this in your billing (even if it is DRG driven) and if you are still held to a productivity standard, then I would have major problems with this.

If the hospial wants to pay me as a PT, but have me act like a CNA, so be it...it's a waste of their own money...just dont' expect me to do anything illegal or then place a productivity standard on top of it.

Toni,

Good patient care is what we should always do.  To ignore the practice act is wrong - follow professional judgement and you will not go wrong.  

However, if a patient is thirsty do you offer a drink to them, or is that not a skilled treatment so you defer to nursing?  How about if the patient is cold.  Do you tell the patient to push the call button and ask nursing for a blanket.  

Common sense should dictate our care, but the rules that govern our profession limit what we do as far as "skilled" services.