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PTA Blog Talk

My Responsibility

Published January 29, 2014 10:26 PM by Jason Marketti

As a provider of physical therapy services, I'm often asked about information not related to my position. Questions regarding insurance coverage, co-pays, length of stay etc. are all technically outside my expertise as a PTA. I could answer these questions, and more, but often choose not to and defer them to another department or to a supervisor.

This brings me into a gray area regarding participation with therapy services. Who is responsible to educate and ensure the patient will actively work with therapy? My argument is that I provide the service but do not coerce or beg the patient to work with me. I might educate the patient on the benefits of therapy but cannot force the patient to work despite needing another 30 minutes to reach the RU level of reimbursement. The MDS provider may not agree, but therapy, like any other prescription, can be refused by the patient at any time.

Patient participation is not necessarily my problem or responsibility. It is a facility's problem when a patient doesn't want to do therapy. What does the facility do when a patient refuses his medication? Does the facility run to the manufacturer of the medication and demand they get the patient to take it? No, they simply write an "R" for "refused" in the medication chart and move on. But with therapy, a facility will quietly demand we get the minutes or there will be heck to pay for weeks and months to come. This is insane.

Soon the facilities will be demanding that therapy collect co-pays and give us a coin purse to carry around because they're having a hard time with collections. When will we step back and stand up and allow another person's difficulty to become his problem and not ours? If a facility wants RUs on patients, it can be more selective with admissions. The admission clerk can also educate the patient regarding therapy and the need to participate every day. I have yet to hear an MDS nurse or an admissions clerk educate a patient regarding RUG levels and reimbursement rates in relation to therapy participation. When that happens, I'll make the facility's problems my responsibility.

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I am a PTA who has worked in In-pt., out-pt., SNF, home  health. I always love the "challenge" of a patient refusal because it let's me express the virtues of our profession, the qualifications of the PT's and finally, my plans on how we are going to accomplish the goals set forth.  I've never had a patient I couldn't win over, so to speak; or one, who after participating, didn't express their gratitude for the understanding extended to him/her.

Maybe a change or treatment environment would work for you, so that you can give your best to the patients, your employer; and most importantly, yourself!

Edie Watson February 7, 2014 2:58 PM

The PT should educate the patient at the eval what to expect when another therapist comes through the door the next day to work with the patient.  Obviously the PT's are not doing their job.

And when the PT's don't do their job it makes it harder for the PTA to do theirs.

The PT's should be well versed in RUG levels and rates of reimbursements as well as consequences for non participation and this information should be given to the patient at the onset of therapy.  Obviously the PT's are failing in this area too or else there would be no refusals.  

And if a patient is coerced, shamed, or tricked into doing any therapy after saying "NO" once, you are in effect violating their rights and should be prosecuted.  "NO" really does mean "NO".

Greg Stephenson, rehab - PTA January 30, 2014 9:41 PM

Jason, I agree with David from Az,  This post makes you sound burned out to me.  As a PT, I certainly feel it is my job to interact with the patient in a way that motivates him to participate in what I have to offer.  Part of my skill as a PT is in helping patients with adherence and motivation. Compassion and creativity are essential in our field. I don't ever force anyone do some thing they don't want to do, but I rarely accept a refusal.

Patricia, neurorehab - PT January 30, 2014 7:10 PM

For the most part I agree with you, Jason. Often times facilities are concerned with meeting Rug levels and demanding the therapist get required minutes with the patient. Many factors play a part in meeting the rug level with SNF patients. If a patient is consistently refusing and we are still being "forced" into reaching a particular rug level, I have a huge problem with that. In my 18 yrs of experience, it doesn't matter who talks to the patient, PT, PTA, Nurse etc. I don't think anyone in the medical profession has some kind of magically powers or 'special' qualifications to which a patient will respond to our requests. We can simply educate, provide rationale & benefits of therapy services, desired outcomes and hopefully(given the patients cognitive state) patient will see the positive side of participation in therapy. On the other hand, if the patient chooses not to participate, after given ample opportunity, the patient should be discharged from therapy services. Certainly, if therapy is the only service skilling the patient to be in the facility and it continued to happen consistently, a facility would have to adjust the patient selection. Or, at least educate during the screening/admissions process.

Julie, SNF January 30, 2014 7:09 AM

I am a PTA and work in a SNF. If a pt refuses I believe it is our responsibility to educate the patient on the benefits of therapy. I am not as concerned about their RUG level as I am their goal to return to their PLOF. If I feel a pt cannot tolerate an Ultra or is refusing for valid reasons I discuss with the rehab team and we make changes. If they are challenging unmotivated patients then they are given the "come to Jesus" talk and usually their attitude turns around. I agree with everything David said... Maybe you are getting tired of the SNF setting and need a change.........

Kathryn, PTA January 29, 2014 9:01 PM

Completely agree with your first paragraph, but other than that, I would disagree with "gray" area.

If you're educating the patient on the exercises, proper techniques, and benefits of physical therapy that should be enough to get them work with you as long as you need them to?  

"Patient participation is not necessarily my problem or responsibility"  Biggest BS/slacker statement I have heard!!!...take responsibility for your profession and step up to the plate!  It is your responsibility to let the patient know the importance of their care at any cost$ or time.

If the patient truly does not want to participate after the explanation of benefits of PT and the reason why they are getting Physical Therapy then, True, you cannot force them to stay.  The Physical Therapist should consult with them and then discharge is required....But also know that if the patient decides to stay after speaking with the Physical Therapist and not you, then YOU are not doing your job.

I would not let your current employer see this post.  Or any other PTA...you are obviously not fit to be a spokesperson for your profession.  I'm sure there are many PTA's out there that do not agree with your statement either... I have 2 at my clinic currently!

WOW, you blew my mind!

David , physical therapy - Owner/PT January 29, 2014 8:17 PM
Chandler AZ

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About this Blog

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