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Toni Talks about PT Today

Do All Medicare Part A Patients Need Therapy?

Published December 3, 2015 5:11 PM by Toni Patt

Today the answer is yes, particularly if the patient is a resident of the facility who went out with a medical problem. Not only do these patients need therapy, they need to be on caseload as long as possible. It is the only way a SNF can survive.

Years ago, what I refer to as "back in the day," we had the same scenario. We were encouraged to pick up all Part A patients. The difference was they weren't on caseload very long. Today we're pressured not only to pick them up but to keep treating them as long as possible. Doing so helps the financials.

The facility I'm working at right now is barely surviving. Several residents have developed medical problems resulting in hospitalizations. I wouldn't say the reaction is gleeful when someone goes out, but there is a sigh of relief. They might actually make budget this month.

Obviously decisions about who to put on caseload and for how long are based on clinical judgment, or should be. It's beyond troubling that our current reimbursement structure produces an environment where staying solvent is so difficult. Everything has been cut to the minimum and SNFs still lose money. It won't be too long before current employees have their salaries reduced.

It's causing a conflict of interest. I decide who is on caseload and how long. My salary is dependent on the facility not losing money. If I pick up everyone for therapy for as long as possible then I keep my salary, which might not be in the patient's best interest. If I maintain the caseload based on what's best for the patient, my salary is in danger.

I don't think the situation has gotten that severe yet, but we can't survive much longer as we are now.

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Working in home health, I have also seen a trend of my supervisors to change my POC orders (without my approval) to extend medicare patients through an entire certification period and then send me to do recertification for another 2 months even when I don't believe that skilled care is required or the patient is not truly home bound and many time non compliant. I am all for giving a patient what they need if the care is skilled and medically justifiable and falls within medicare guidelines but am very much against over utilization of care to boost the financial needs of a company.

Joanne December 1, 2016 10:45 PM
Granada Hills CA

I have been in facilities where patients adamantly refuse therapy but the administrator highly encourages the PT department to see the patient regardless of their right to refuse treatment.  

If a PT clinically decides not to place a patient on caseload there are plenty of other facilities that will.  Patients and family can shop around for the facility of choice where the PT department will pick up every patient regardless of diagnosis or need.  

Patients do this with MD's when they do not like the results of an assessment of their diagnosis.  Sometimes it is better to provide a service to a patient (and family) than to do nothing.  

How many MRI's, blood tests, x-rays, etc. are done just so the provider can say and look as if they did something even though they know and understand that the results will not be different.  Clinical skills become secondary when a business needs to stay afloat.  

To further detail this point, when riding in an ambulance patients are often given and charged for oxygen use, how many actually need the supplemental oxygen when their SPO2 is above 92%?

That is the harsh reality because of the reimbursement we currently have in the U.S.

Greg December 5, 2015 10:56 AM

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