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PTA Blog Talk

Progression

Published April 29, 2009 4:08 PM by Jason Marketti
Therapy treatments should show progression, and insurance companies will approve treatments as long as the patient will progress.  This is probably why few PTs are in hospice care.

But what about PD and dementia-related diseases that are slowly progressive in attacking the brain?  If insurance companies hesitate to approve physical therapy in hospice care, how do they justify approving care with other diseases that are just as debilitating in nature?

In six months, a person with dementia can go from stand by assist to max assist and insurance companies will continue to approve therapy car. Yet someone with metastatic bone cancer has a potential to go from moderate assist to CGA in less than six months, but insurance may not approve treatment. Why?

In acute care, therapy is provided but it is limited until the next level of care for that patient. In order for a patient to continue to progress, they will need therapy but hospice and insurance companies often have their own agenda for what the patient will need.  It seems once a patient is on hospice they are forgotten and are expected to die, yet I have seen patients go on and off hospice for a year or more and PT will pick them up every time they are off hospice.  It would seem easier to keep the patient on hospice and still provide therapy services as needed for transfers, stretching, and patient and caregiver education. 

It surprises me that insurance companies will pay for pediatric care for some of the patients that are too slow to progress over a school year and there are pediatric brain impairments that are progressive in nature, yet they continue to receive treatment from therapy until the child is 21.

Why do we continue to allow insurance companies to dictate who we see and why?  If a therapist sees a need to intervene and can justify services, shouldn't that be enough for an insurance company? Or are we puppets in an insurance company's play? How long will we continue to dance?

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About this Blog


    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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