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PTA Blog Talk

'Because I Said So'

Published November 7, 2012 6:37 PM by Jason Marketti

A PTA came up to me and asked why a patient was on caseload. The patient recently had a THA, was independent with transfers, able to follow an HEP independently and walking more than 150 feet with an SPC. Vital signs were within normal limits with activity and the patient was weaning off pain medication in preparation for going home. A home assessment had not been done on this patient and there was some question if one was even needed. I suggested the PTA talk it over with the PT and from there they could formulate a plan of care or discharge the patient.

I'm a fan of allowing the PTAs to suggest POCs and encourage them to be actively involved when discussing the patient's progress and discharge planning. Of course, the final decision is up to the PT, but a phrase like "Because I said so," is not an appropriate reason to keep a patient on caseload. There should be a functional deficit or an objective measurement we can work toward improving to show progress. When there's a question if a patient should be discharged, I look at the goals (both short-term and long-term) and assess whether the patient has met them or not. If the goals are met, the PT needs to reassess the patient and determine, with the PTA's professional input, if the patient is clinically appropriate to continue with therapy.

I've worked with PTs who will keep a patient on caseload because they know the patient's family or they both go to the same church. I've seen goals change from 300 feet of gait to 500 feet, Tinetti goals from 25/28 to 28/28 and Berg scores updated from 45/56 to 50/56. Yes, these are measureable goals but is there good clinical reasoning behind the updated goals or are they being changed just to keep the patient on therapy? And should I be questioning the clinical judgment of the PT when he updates the goals like this?


Anecdotes are unimpressive and I could give many about PTA's as well, big deal. PT's/PTA's should be working together to do what is best for the PATIENT, not throwing one another under the bus. I have never met a PT who didn't have the patient's best interest in mind when making a decision to continue a patient or D/C, in any setting. No clinician should ever make a decision with the insurance company's interest at the forefront.

B November 25, 2012 11:53 AM

Jason - not only is the Supervising PT negligent, but he/she is also practicing fraud, especially if this patient is Medicare insured. As a Medicare reviewer, I would seriously question this therapist's Plan of Care and treatment protocol to see if it indicated reasonable functional goals. if not, the claims would most definitely be denied. Medicare fraud runs rampant and patients being treated beyond their needed therapy is high on the watch list. Good for you, and keep asking (remember, if any claims are reviewed, YOUR name is also on this chart!).

al dimicco, Ortho/sports - Director November 8, 2012 1:27 PM
Bessemer AL

Using "I said so" to keep a patient on case load is also unethical.  Just because I can write a functional goal, such as increasing a Tinetti score to 28/28 doesn't mean it is realistic or necessary.  Both the Berg and Tinetti measure fall risk as either yes or no.  A patient is not less of a fall risk if they score 28 instead of 25 on the Tinetti.

Toni November 7, 2012 6:48 PM

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About this Blog

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