Can a Physical Therapy Assistant work directly for a physician?

[BACMEDIC]

Sorry if this is the wrong place to post this question but I did not see any other place appropriate.

My wife is a PTA with extensive experience, mostly in outpatient. I will be graduating soon in FM and wondered if she could work directly for me as a PTA.

I know a PTA cannot evaluate, but they can treat. My thought is to do the evaluation and instruct her on the treatment plan (the Rx part) and have her carry it out, then bill for PT services.

Can this be done or is it that a PTA can only work for a PT?

Any help is greatly appreciated - thanks.

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[mshheaddoc]

Don't know straight answer but here are the medicare guidelines ...

http://www.cms.gov/manuals/Downloads/bp102c15.pdf

sections 60 and 220, 230 would be of interest.

Also --- http://oig.hhs.gov/oei/reports/oei-09-02-00200.pdf

 

[1UP]

Sorry if this is the wrong place to post this question...

You can't possibly conceive of how very wrong a place this is for your question.

 

[DrMom]

moving to the physical therapy forum

 

[BACMEDIC]

moving to the physical therapy forum

I looked in the PT area - seems to be student based, school discussion and such. Like when I was trying to get into med school, the details of practice were not even on the horizon.

Thanks mshheaddoc, I think that is what I was looking for.

 

[DrMom]

The lounge is for fun stuff only.

 

[mtm34]

This may vary from state to state but the practice act in Pa. states a PTA can only perform physical therapy under the supervision of a licensed PT. I believe this is how it is in most places to prevent the situation you described (where patient conflict of interest can come into play). There are practicing PT's and PT students on this forum- you should get a clear answer in the next few days.

 

[Fiveoboy11]

BACMEDIC,

In what way do you think you're qualified to do a physical therapy evaluation and set up a treatment plan? Are you a physical therapist?

I have been one for about 3 years now (DPT), and have to say that this type of thing is the single worst part of the job. Ignorance among other health care practitioners. Stick to your specialty in medicine. You won't be hearing me imply that I'm qualified to practice medicine any time soon.

 

[Yohan]

Sorry if this is the wrong place to post this question but I did not see any other place appropriate.

My wife is a PTA with extensive experience, mostly in outpatient. I will be graduating soon in FM and wondered if she could work directly for me as a PTA.

I know a PTA cannot evaluate, but they can treat. My thought is to do the evaluation and instruct her on the treatment plan (the Rx part) and have her carry it out, then bill for PT services.

Can this be done or is it that a PTA can only work for a PT?

Any help is greatly appreciated - thanks.

This should answer your question, straight from the APTA website:

"Physical therapist assistants (PTAs) provide physical therapy services under the direction and supervision of a licensed physical therapist"...

 

[goyo1010]

Sorry if this is the wrong place to post this question but I did not see any other place appropriate.

My wife is a PTA with extensive experience, mostly in outpatient. I will be graduating soon in FM and wondered if she could work directly for me as a PTA.

I know a PTA cannot evaluate, but they can treat. My thought is to do the evaluation and instruct her on the treatment plan (the Rx part) and have her carry it out, then bill for PT services.

Can this be done or is it that a PTA can only work for a PT?

Any help is greatly appreciated - thanks.

A PTA can only work under the DIRECT SUPERVISION of a physical therapist. A physican cannot hire a PTA for any reason, unless there will be a PT present that will supervise the care the PTA administers--even if the physician gives the Rx for rehabilitation or any other treatments. This is out of the PTA's scope of practice and is not legal.

Don't take the other hostile posts in the wrong way. A physician in FM is simply not adequately equipped with the skill and knowledge (lack of depth in MSK) to safely evaluate and prescribe physical therapy for the patient--unless that physician also happens to be in PM&R or orthopedics.

Unfortunately, no PT. No PTA.

 

[ChiTownDPT77]

BACMEDIC,

In what way do you think you're qualified to do a physical therapy evaluation and set up a treatment plan? Are you a physical therapist?

I have been one for about 3 years now (DPT), and have to say that this type of thing is the single worst part of the job. Ignorance among other health care practitioners. Stick to your specialty in medicine. You won't be hearing me imply that I'm qualified to practice medicine any time soon.

You, personally, offend me. I didn't work my a** off for a DPT so that I can work with arrogant, moody, "chip on my shoulder all the time" colleagues who give our profession a bad reputation.

I have long been silent on this board, but enough is enough.

**Public Service Announcement**
DPT's, or any PT's for that matter, are not *generally* narcissistic people who are difficult to work with or who act like they are the absolute shiznit. In reality, we work well in interdisciplinary environments, and professionally respect other healthcare providers--- because....that's what classy people do. And, we are usually known as the really cool, smart people who are awesome at what we do.

FiveO, type what you want, make a d*mn fool of yourself at the expense of our precious DPT title, but know that even "Equals" around the country, ie (those with a DPT in your eyes), think that you are a complete idiot. Thanks for keeping DPT classy.....

 

[Quenchaid]

I was just gearing up to smash FiveO's petty little pea brained ego with my keyboard but glad to see someone else already stepped up.
You spend 3 years in grad school and you think you are hot ish. Guess what? Docs do 4 years of med schl then they work for free for 3 years for free (residency should be renamed volunteering but hey that's just my personal opinion)... minimum.

If PTA's can only work for PT's say that and back it up if you actually want to be helpful. Keep your snide remarks to yourself jerk.

 

[PTapp]

^ You guys are funny. If the MDs can do PT evals and treatment, then why the hell do we go to PT school and become PTs? What is the point really? I know for a fact that MDs go through hell to get their degrees, and they certainly deserve all the recognition and all that, but hiring a PTA and billing for PT services? Are you guys okay with that? What kind of PT evaluation would an MD perform? I dont get it.

 

[Quenchaid]

No we are not okay with that. I don't think an MD is qualified to do a PT evaluation. As the name indicates, it's a Physical Therapy Evaluation which means a Physical Therapist is required to do the Eval and come up with a Plan of Treatment if necessary. I think if he wants his wife to work in his practice he will need a Physical Therapist on staff to do the Eval's (even if it's a part time gig for the PT).

I don't have proof, just my humble observation from hospitals and home health settings I've worked in.

 

[hefe]

I'd like to hear a poster jesspt's or more practicing PT's answer on this issue, probably would know more. Many of those that use this forum are applying or possibly current PT students.

A variety of questions for you to consider on the subject.

My humble opinion as a current student is that I doubt an FM physician is capable or has enough training/assessment knowledge in the muskuloskeletal area for a proper PT evaluation/treatment even if they wanted to do it. If anything, PMR (possibly ortho) would have much more relevant skills/training to do such assessment. Why don't you talk to some PMR physicians and ask how the muskoloskeletal training of FM is compared to what they've done. I think you'd be in for a surprise, just because you're an MD resident and fresh in the field are you really qualified in this area amongst better practitioners that provide this service?

Honestly, start reading the state's practice laws for medicine and physical therapy if you want an answer directly from the source. Do you really wish to subject inferior treatment by referring to your wife even if you legally could?

Where's the ethics in that when an FM physician is trying to play pseudo PT to be able to self-refer and bill for profit with inferior service that the system was not designed?

Lastly, I'll leave you with this hypothetical: Would a PT practice with no physician involvement be able to hire an unsupervised Physician Assistant and bill out for MSK medical treatment like prescriptions and injections just because it would be convenient for them and make them money?

A resounding NO... Not in a million years. Separate professions. MD's have extensive training, but as an FM in training there should be ethical limits you place on yourself on what you do to fit within your scope of practice. Is it right to present present "shoddy goods" for PT treatment and bill insurance for it?

Perhaps, if you want to supervise a PT Assistant you should go to physical therapy school and get your DPT. This is what MD's do to supervise the respective PA's...
OR you should just hire a licensed Physical Therapist.

 

[hefe]

Also, sorry to read inflammatory discussion earlier. But this topic does strike a bug when you think about it. This is because you're diminishing one professions training/scope and holding high the other. You're bound to push some people's buttons.

 

[Quenchaid]

Why would anyone in their right mind want to work with their wife anyway?

 

[Quenchaid]

According to Google

Query: Physical Therapy Assistant Guidelines

40.2 - Physical Therapy Services [FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman](Rev. 111, Issued: 09-25-09; Effective Date: 07-07-08; Implementation Date: 10-26-09) ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]Qualified physical therapist,
.
.[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]as defined at 42CFR485.70(e), ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]has the knowledge, training, and experience required to evaluate and reevaluate..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman], as appropriate, ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]a patient's level of function, determine whether a physical therapy program could reasonably be expected to improve, restore, or compensate for lost function, and recommend to the physician a plan of treatment. The skills of a qualified physical therapist are required to evaluate and reevaluate the patient's level of function and to develop..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman], in consultation with the physician as appropriate, ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]the ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]physical therapy ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]plan of treatment. A qualified physical therapist assistant ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman](PTA), as defined at 42CFR485.70(e), ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]functioning under the supervision of the qualified physical therapist may carry out ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]certain procedures of ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]the ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]physical therapy ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]plan ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]of treatment..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman], in accordance with applicable State laws. ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]Only the p..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]hysical therapist..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman], not the PTA can ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]conduct the discharge visit as this visit is viewed as the final ..[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]assessment of the patient's progress toward attaining the goals of the physical therapy plan of treatment. ..

Source: https://www.cms.gov/manuals/Downloads/bp102c12.pdf

Query: Physical Therapy Assistant Supervision

What are the Supervision Requirements for Physical Therapist Assistants?

The supervision requirements are in Section 1398.44 of the Physical Therapy Regulations.
Adequate Supervision Defined
A licensed physical therapist shall at all times be responsible for all physical therapy services provided by the physical therapist assistant. The supervising physical therapist has continuing responsibility to follow the progress of each patient, provide direct care to the patient and to assure that the physical therapist assistant does not function autonomously...

Source: http://ptbc.ca.gov/forms_pubs/ptasuper.shtml

Query: Can a Doctor supervise a Physical Therapy Assistant

Billing PTA services ‘incident to' doctor services FAQ

Q: Can services of a physical therapy assistant be billed "incident to" a doctor's services?
A: No. The services provided by Physical Therapist Assistants (PTAs) cannot be billed incident to a physician/NonPhysician Practitioner's (NPP), because they do not meet the qualifications of a therapist. Only the services of a licensed/registered physical therapist can be billed "incident to" a physician service. PTAs may not provide evaluation services, make clinical judgments or decisions or take responsibility for the service. PTAs act at the direction and under the supervision of the treating physical therapist and in accordance with state laws. The services of the PTA are only billable when provided under the direct supervision of the physical therapist and under their National Provider Identifier (NPI) number.
Source: CMS Internet-only Manual (IOM) Pub. 100-02 Medicare Benefit Policy Manual, Chapter 15 Covered Medical and other
Health Services, Section 230 Practice of Physical Therapy, Occupational Therapy, and Speech-Language Pathology
[FONT=Times New Roman,Times New Roman][FONT=Times New Roman,Times New Roman]..
Source: http://www.cms.gov/manuals/Downloads/bp102c15.pdf

 

[goyo1010]

well, that settles it.

 

[ptinaz]

My understanding is the answer is a little convoluted.
For a patient under Medicare, easy answer = no. PTA cannot bill for 'incident to' MD. But reimbursement is the easy part and not a legal standard.
In the state I practice in, a PTA must be supervised by a PT. Simple enough. But if an MD had an employee who performed therapeutic exercise, manual therapy, gait training, etc, etc under the MD supervision, and that person did not sign their name 'PTA' or was not licensed, or did not tell anyone they are a PTA, well then it is probably legal. Primarily because if the PTA is not licensed or working as a PTA (using those initials or telling people she is one), then the state PT board has no jurisdiction. So there is not really a recourse.
So maybe possible. If you think a patient needs PT, it is probably best for the patient for you to have that patient see a PT. All of health care should be a focus on the patient rather than other things that tend to muddy the waters of optimal patient outcomes. We are specialists in our scope of practice, so please think about PT as another specialist you may think a patient would benefit from (e.g., neurologist, psychologist, orthotist, etc).

 

[Fiveoboy11]

Wowzers,

I don't know that I've ever been owned quite like that before. ChiTownDPT77, I have to say that I respectfully disagree that I have been arrogant on this message board. I'm simply trying to defend the profession of PT, and not to mention all OUR hard work. I have no tolerance for another profession implying they are qualified to practice PT, and when I see it I react harshly and abruptly. I think it is made quite obvious working as a PT and on this message board that there is astonishing lack of professional respect towards PT's. It is as if medically trained practitioner's think physical therapy is a medical procedure that they can just "order." And since they can order it, they are qualified to provide it.

By the way, I do have a chip on my shoulder. I am extremely passionate about PT and if you'd prefer someone who's just easy to get along with rather than someone who advocates for what's right, then that's your issue.

I definitely can stay off this message board if enough people have a problem with me though.

 

[Fiveoboy11]

I was just gearing up to smash FiveO's petty little pea brained ego with my keyboard but glad to see someone else already stepped up.
You spend 3 years in grad school and you think you are hot ish. Guess what? Docs do 4 years of med schl then they work for free for 3 years for free (residency should be renamed volunteering but hey that's just my personal opinion)... minimum.

If PTA's can only work for PT's say that and back it up if you actually want to be helpful. Keep your snide remarks to yourself jerk.

Quenchaid,

I'm well aware of the years of training and MD/DO goes through. That's precisely why you don't see me saying I can practice medicine.

The reason why PTA's need a PT's supervision is based upon state law. The professional curriculum PT's and PTA's go through are impacted by this relationship. PTA's are specially trained to assist a physical therapist in the provision of physical therapy. PTA's are not specially trained to assist an MD/DO in physical therapy. A physician is not trained to do a physical therapy evaluation. PTA treatment is based upon the PT evaluation, interaction with the PT. Not only do many MD/DO's clearly not understand their roles relative to PT, how in the world would the provision of PT by a PTA with an MD/DO supervising be appropriate? To clarify, it would not necessarily be the PTA as the weak link in this scenario as they actually are trained in PT. A MD/DO is NOT trained in PT and thus it doesn't even make sense from a 1st grade intelligence level train of thought.

Let me know if I need to further explain obvious things.

 

[goyo1010]

Fiveoboy11 makes very valid points with which I agree. I think it's just how other people take the tone of the posts.

 

[TheOx777]

1. I did not get the sense that the OP was in any way trying to do something "shady" like bill for PT when they were not legally qualified to do so. They seemed to be honestly trying to find out whether their spouse(PTA) could perform aspects of PT and bill for it under a FM docs supervision. As a person who wants to be business-minded and service oriented, I think I see where they are coming from.

2. As a student who will be starting my DPT training this fall(small disclaimer), I have to agree with Fiveboy. While his marks have proven to be incendiary (given the feedback), they are ultimately true IMHO. SOOOOO many physicians, medical Students, and pre-meds get absolutely IRATE that any other health care profession acutally has a "D" for doctor in their title. That said would you want a rheumatologists performing a root canal or oral maxillofacial surgery(I know a orthopod could do it but work with me)? Probably not! Now would that same rheumatologist want a DDS/DMD evaluating, diagnosing, and treating their kid's reconstructive knee rehabilitation after a sports injury(PT's job)? I would hope not!
Healthcare is extremely fragmented, which in turn causes these "turf wars." At the end of the day, we are all in this together(cheesy but true). When we are not, guess who suffers? Our patients! When they are unhappy, nobody is going to make any money or have any sense of autonomy.

Ultimately, I think the OP had sincere intent to find out the answer to a question. I also think Fiveboy, while fired up, made some valid points. We all have to stay in our lanes, yet it is probably even more important to educate ourselves about every other aspect of the health care world just in case we are not sure which lane to stay in.

 

[jesspt]

1. I did not get the sense that the OP was in any way trying to do something "shady" like bill for PT when they were not legally qualified to do so. They seemed to be honestly trying to find out whether their spouse(PTA) could perform aspects of PT and bill for it under a FM docs supervision. As a person who wants to be business-minded and service oriented, I think I see where they are coming from.

Nor did I. The OP seems to just be naive in regards to the practice of rehabilitation. It is this just type of question that allows us an opportunity to educate a future physician in FM, who may someday have a practice where patients with musculoskeletal complaints make up a considerable part of his practice. We could of course, alienate him now, with defensive posturing and angry posts, or we could actually start a dialogue with him. Looks like some of the previous posters opted for the former. And Fiveoboy, if you can't see how someone would misinterpret your posts, you have some serious self-awareness issues that I think you should address. Hell, quite a few of the posters here who share your viewpoint took offense at your posts.

What about the OP's wife, who is...

a PTA with extensive experience, mostly in outpatient.

Should we perhaps, be just as concerned with her, as she has been in the field, working with patients, and quite possibly sees nothing wrong with the scenario the OP suggests?

I am a staunch and passionate advocate for patient empowerment, and direct access to physical therapy services can become a large part of that. Scenarios like this (and POPTs to a much larger extent) endanger that. But, flying off the handle does no one any good. We can't change the way that many physicians view our services unless we do at the very least, two things extremely well:

1. Provide quality, cost-effective, value driven, and patient centered care for every patient who walks through our doors
2. Educate those physicians we come into contact with about our professionalism, our depth and breadth of knowledge, and our willingness to what is in the best interest of every patient we treat.

I am certain that many on this board currently are ready for the first part, or will be once they begin practice. It is unfortunate that some show no interest or ability in the second.

 

[MinnDasota]

Nor did I. The OP seems to just be naive in regards to the practice of rehabilitation. It is this just type of question that allows us an opportunity to educate a future physician in FM, who may someday have a practice where patients with musculoskeletal complaints make up a considerable part of his practice. We could of course, alienate him now, with defensive posturing and angry posts, or we could actually start a dialogue with him. Looks like some of the previous posters opted for the former. And Fiveoboy, if you can't see how someone would misinterpret your posts, you have some serious self-awareness issues that I think you should address. Hell, quite a few of the posters here who share your viewpoint took offense at your posts.

What about the OP's wife, who is...Should we perhaps, be just as concerned with her, as she has been in the field, working with patients, and quite possibly sees nothing wrong with the scenario the OP suggests?

I am a staunch and passionate advocate for patient empowerment, and direct access to physical therapy services can become a large part of that. Scenarios like this (and POPTs to a much larger extent) endanger that. But, flying off the handle does no one any good. We can't change the way that many physicians view our services unless we do at the very least, two things extremely well:

1. Provide quality, cost-effective, value driven, and patient centered care for every patient who walks through our doors
2. Educate those physicians we come into contact with about our professionalism, our depth and breadth of knowledge, and our willingness to what is in the best interest of every patient we treat.

I am certain that many on this board currently are ready for the first part, or will be once they begin practice. It is unfortunate that some show no interest or ability in the second.

Thanks Jess! My sentiments exactly.

I too was more concerned about the OPs wife, practicing as a PTA, not seemingly (I can only guess) having a problem with the scenario. She should know that a PTA can only practice under the supervision of a PT. So the question posed by the OP should've been answered at home! No need for us.

 

[Medicus_Amicus]

BACMEDIC,

In what way do you think you're qualified to do a physical therapy evaluation and set up a treatment plan? Are you a physical therapist?

I have been one for about 3 years now (DPT), and have to say that this type of thing is the single worst part of the job. Ignorance among other health care practitioners. Stick to your specialty in medicine. You won't be hearing me imply that I'm qualified to practice medicine any time soon.

Physical therapy is part of science of medicine. The definition, medicine is the science and practice of the diagnosis, treatment, and prevention of disease. The treatment or therapy are synonyms, the last is Latin version of it. The therapy is main constituent of being a physician - and it is very comprehensive including pharmacotherapy, physiotherapy and psychotherapy. These are therapies that we order, perform to some extent and follow up on routinely. Especially PM&R physicians who not only oversee theraputic but also clinical and diagnostic services in the physical/rehabilitation treatment field. We have heavily relying on physical therapists to achieve success in overall medical treatment. So, you are welcome you are medical professional as I am.

 

[Bones26]

Way to unearth a thread that died > 5 years ago.

 

[Ndebt]

I thought it was ironic that your user name is bones

 

[Fiveoboy11]

Physical therapy is part of science of medicine. The definition, medicine is the science and practice of the diagnosis, treatment, and prevention of disease. The treatment or therapy are synonyms, the last is Latin version of it. The therapy is main constituent of being a physician - and it is very comprehensive including pharmacotherapy, physiotherapy and psychotherapy. These are therapies that we order, perform to some extent and follow up on routinely. Especially PM&R physicians who not only oversee theraputic but also clinical and diagnostic services in the physical/rehabilitation treatment field. We have heavily relying on physical therapists to achieve success in overall medical treatment. So, you are welcome you are medical professional as I am.

Use whatever definition, latin origin, or anything you want. The fact is physicians are not trained or qualified to provide or prescribe or supervise any aspect of physical therapy for any patient under any situation. They may be told they are and they may be handed the power under insurances and institutions but they're not trained or qualified. How could they be given the fact the majority have no physical therapist observation hours, no formal demonstration of competence formally under criteria from a physical therapy authority, and no physical therapy classes. All we have here is a flawed design with catastrophic consequences, such as: false sense of expertise among physicians and other non physical therapists re physical therapy, and exploitation of physical therapy and physical therapists by non physical therapists (i.e. Institutional protocols, physician ownership, travel/contract agencies). Given the design of the healthcare system we have now that physical therapists are forced to work in we get this poster who thinks they and their group know what's impossible for them to know.

 

[webcrest]

PTs tend to be more analytical, questioning, perceptive, challenging.
PTAs tend to be more problem-focused, detail-oriented, like to have a set of goals and work towards them. They get the treatment plan and work towards it. The PT evaluates the patient and has to be able to assess what's really going on.
Now in reality, I've met PTAs that were better at assessing a patient, and PTs that really are better at following a treatment plan then evaluating a patient, BUT, like I said, this is the pattern!