Who Directs Patient Care?
A while ago, a patient came into the facility and we were given two weeks to make the patient stronger and safer to go home. The two weeks was what the patient's insurance company authorized. Research shows that a person will need to increase caloric intake and lift heavier weights with shorter repetitions to increase strength. The person should also come to the therapy gym two to four hours a day and rotate body parts, doing chest, arms and lower-body exercises on alternate days to guarantee an increase in overall strength and performance with safe activity. Unfortunately this will not occur.
Two weeks is generally not enough time to increase strength in an older adult who is already debilitated from spending time in a hospital. Maybe I could talk to the facility's nutritionist and explain that the patient needs to eat six small meals a day with an increase in protein and fresh vegetables so therapy can achieve the goals dictated to us by the insurance company. My seven other patients are Medicare part A and are reimbursed by the minutes, not the outcome of service provided. I still have 99 more days to achieve their goals.
If the PT is supposed to direct the care of a patient, he's immediately overruled by the insurance company because they will only authorize two weeks of care. So even before a POC is written, the length of stay is dictated and any long-term goal set greater than two weeks is moot. I'm not sure if an advanced degree is required to take orders from an insurance company. Maybe I'm mistaken, I've been wrong before.